Provider Demographics
NPI:1790763886
Name:KONEFAL, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:KONEFAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9536 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413
Mailing Address - Country:US
Mailing Address - Phone:757-442-6050
Mailing Address - Fax:757-961-3696
Practice Address - Street 1:9536 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-442-6050
Practice Address - Fax:757-961-3696
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033463208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15317OtherSENTARA HEALTHCARE
VA331810OtherANTHEM BC BS
VA007502290Medicaid
B09543Medicare UPIN
VA340012065Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA007502290Medicaid