Provider Demographics
NPI:1780782037
Name:KON, RAPHAEL B (DO)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:B
Last Name:KON
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 1:502 SR 29 S
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1735
Mailing Address - Country:US
Mailing Address - Phone:570-836-3316
Mailing Address - Fax:570-836-6036
Practice Address - Street 1:502 SR 29 S
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1735
Practice Address - Country:US
Practice Address - Phone:570-836-3316
Practice Address - Fax:570-836-6036
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007528L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine