Provider Demographics
NPI:1336140748
Name:KONICK, DANIEL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:KONICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:125 SHOREWAY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1666
Practice Address - Country:US
Practice Address - Phone:410-827-4001
Practice Address - Fax:410-827-4333
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-05-24
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Provider Licenses
StateLicense IDTaxonomies
MDD0032353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD248738OtherMAMSI SPECIALIST
MD159031600Medicaid
MD529991-06OtherCAREFIRST MD RENDERING
MD7605-0043OtherCAREFIRST BLUECHOICE
MD848738OtherMAMSI PRIMARY CARE
MD3086076OtherCIGNA PIN
MD5360473OtherAETNA FEE FOR SERVICE
MD0927385OtherAETNA CAPITATED
MD032388OtherJHHC PROVIDER NUMBER
MDP12855OtherCAREFIRST MPOS
MD110183169OtherRR MEDICARE
MD5360473OtherAETNA FEE FOR SERVICE
MD848738OtherMAMSI PRIMARY CARE