Provider Demographics
NPI:1477592244
Name:KONKEL, KAREN E (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:KONKEL
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 1:7801 YORK RD
Mailing Address - Street 2:SUITE102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-769-4920
Mailing Address - Fax:410-296-4205
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-769-4920
Practice Address - Fax:410-296-4205
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50736207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028902761Medicaid
MD132190100Medicaid
MD132190100Medicaid
MD028902761Medicaid
MDK802Medicare PIN
MD211855Medicare Oscar/Certification