Provider Demographics
NPI:1619930559
Name:KOENIG, MARIANNE SARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:SARAH
Last Name:KOENIG
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 1:449 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2339
Mailing Address - Country:US
Mailing Address - Phone:508-888-8430
Mailing Address - Fax:508-888-6673
Practice Address - Street 1:449 ROUTE 130
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2339
Practice Address - Country:US
Practice Address - Phone:508-888-8430
Practice Address - Fax:508-888-6673
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA500012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA28345OtherCHILDRENS MEDICAL SECURIT
MAS011190OtherTRICARE
MA20140OtherHARVARD PILGRIM HEALTH CA
MAKOJO4544OtherBLUE CROSS BLUE SHIELD
MA1200958OtherUNITED HEALTHCARE
MA3000532Medicaid
MA4849274OtherCIGNA
MA28345OtherCHILDRENS MEDICAL SECURIT
MA4849274OtherCIGNA