Provider Demographics
NPI:1558479394
Name:KONTIS, THEDA CHRISTINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:THEDA
Middle Name:CHRISTINE
Last Name:KONTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE ROAD
Mailing Address - Street 2:SUITE #370
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-486-3400
Mailing Address - Fax:410-486-0092
Practice Address - Street 1:1838 GREENE TREE ROAD
Practice Address - Street 2:SUITE #370
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-486-3400
Practice Address - Fax:410-486-0092
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040743207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD144481600Medicaid
MD830MMedicare ID - Type Unspecified
MD144481600Medicaid