Provider Demographics
NPI:1811975469
Name:KOENIG, DAVID JOHN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:KOENIG
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 1:240 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8346
Mailing Address - Country:US
Mailing Address - Phone:910-721-2070
Mailing Address - Fax:910-721-2074
Practice Address - Street 1:240 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8346
Practice Address - Country:US
Practice Address - Phone:910-721-2070
Practice Address - Fax:910-721-2074
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA297471207R00000X
MOR8N75207R00000X
NC2009-01147208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2107425Medicaid
IA110229063OtherRR MEDICARE
IAI5197Medicare PIN
IA2107425Medicaid