Provider Demographics
NPI:1548497183
Name:PHILIP KONITS MD LLC
Entity type:Organization
Organization Name:PHILIP KONITS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-876-5148
Mailing Address - Street 1:2059 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1301
Mailing Address - Country:US
Mailing Address - Phone:410-876-5148
Mailing Address - Fax:410-876-5149
Practice Address - Street 1:2059 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1301
Practice Address - Country:US
Practice Address - Phone:410-876-5148
Practice Address - Fax:410-876-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24321207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty