Provider Demographics
NPI:1609067354
Name:KOENIGSBERG, BETH (RN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:KOENIGSBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 LASALLE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5914
Mailing Address - Country:US
Mailing Address - Phone:410-887-8746
Mailing Address - Fax:410-828-8346
Practice Address - Street 1:8501 LASALLE RD
Practice Address - Street 2:STE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5914
Practice Address - Country:US
Practice Address - Phone:410-887-8746
Practice Address - Fax:410-828-8346
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166412163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health