Provider Demographics
NPI:1609874692
Name:KOENIG, KARL G (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:G
Last Name:KOENIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:671 HIOAKS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:7001 W BROAD ST
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3701
Practice Address - Country:US
Practice Address - Phone:804-673-2722
Practice Address - Fax:804-282-5723
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101048551207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5873592Medicaid
VA5873592Medicaid
VA110008346Medicare ID - Type Unspecified