Provider Demographics
NPI:1841299641
Name:KONITZKY, PAUL C (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:KONITZKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MAXWELL LN
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2136
Mailing Address - Country:US
Mailing Address - Phone:724-816-1626
Mailing Address - Fax:
Practice Address - Street 1:115 NOLTE DRIVE EXT
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7159
Practice Address - Country:US
Practice Address - Phone:724-545-8000
Practice Address - Fax:724-543-4370
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027281201OtherUNIVERA
NY02664313OtherNY MEDICAL ASSISTANCE
OH2581933OtherOH MEDICAL ASSISTANCE
PAP00244567OtherRR MEDICARE
WV1068906OtherWEST VIRGINIA WORK COMP
PA1746297OtherBLUE SHIELD
PA1545621OtherGATEWAY
PA170154OtherUNISON
PA1013305780001Medicaid
PA410779OtherUPMC
NY00027281201OtherUNIVERA
PA1746297OtherBLUE SHIELD