Provider Demographics
NPI:1801855259
Name:KONEFAL, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KONEFAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8540
Practice Address - Country:US
Practice Address - Phone:704-235-2580
Practice Address - Fax:704-333-3397
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC335382085R0001X
SC142522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC49868OtherBLUE CROSS
NC62133OtherMEDCOST
NC26041OtherPARTNERS
NC8949868Medicaid
SCN33538Medicaid
NC0473851009OtherCIGNA
NC2086292OtherUNITED HEALTHCARE
NC0473851009OtherCIGNA
NC26041OtherPARTNERS
NCE49981Medicare UPIN
NC213628AMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
NC49868OtherBLUE CROSS
SCE499816058Medicare ID - Type UnspecifiedSC MEDICARE
NC8949868Medicaid