Provider Demographics
NPI:1588666978
Name:KONERMAN, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KONERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-912-7211
Mailing Address - Fax:859-655-8981
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:859-912-7211
Practice Address - Fax:859-655-8981
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41236207R00000X
OH35.052189208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000536346OtherANTHEM
OH0659256Medicaid
158866978OtherMEDICAL MUTUAL
OH2565399Medicaid
4065714OtherAETNA
P00419304OtherRAILROAD MEDICARE
KY0399022Medicare PIN
P00419304OtherRAILROAD MEDICARE
4065714OtherAETNA