Provider Demographics
NPI:1134338924
Name:KONEN, JOSEPH C (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:KONEN
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 1:130 SPINNAKER CT
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7102
Mailing Address - Country:US
Mailing Address - Phone:704-655-2558
Mailing Address - Fax:
Practice Address - Street 1:15014 BALLANTYNE COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2719
Practice Address - Country:US
Practice Address - Phone:704-541-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950026Medicaid
NC8950026Medicaid
NCNC1065AMedicare PIN
NC207951GMedicare PIN
NC207951LMedicare PIN
NC207951DMedicare PIN
NC207951FMedicare PIN
NC207951HMedicare PIN