Provider Demographics
NPI:1891822243
Name:KONIECZNY, REBECCA ANN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:KONIECZNY
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 1:323 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:978-783-5000
Mailing Address - Fax:978-313-8180
Practice Address - Street 1:323 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-783-5000
Practice Address - Fax:978-313-8180
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087762AMedicaid