Provider Demographics
NPI:1700852159
Name:KONITS, PHILIP
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:KONITS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0309
Mailing Address - Country:US
Mailing Address - Phone:410-876-5149
Mailing Address - Fax:
Practice Address - Street 1:2059 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1301
Practice Address - Country:US
Practice Address - Phone:410-876-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024321174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508086521OtherNPI
MDC49246Medicare UPIN
MD1508086521OtherNPI