Provider Demographics
NPI:1760505135
Name:KONKUS, STEPHANIE STERRETT (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:STERRETT
Last Name:KONKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:STERRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:TOWN PEDIATRICS
Mailing Address - Street 2:823 S. KING ST
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:703-777-5222
Mailing Address - Fax:703-777-5144
Practice Address - Street 1:TOWN PEDIATRICS
Practice Address - Street 2:823 S. KING ST
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-777-5222
Practice Address - Fax:703-777-5144
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431289208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics