Basic Information
| Provider Information | |||||||||
| NPI: | 1184691628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONOPKA | ||||||||
| FirstName: | MONIKA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALCZAK | ||||||||
| OtherFirstName: | MONIKA | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2527 CRANBERRY HWY | ||||||||
| Address2: | |||||||||
| City: | WAREHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025711046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008415200 | ||||||||
| FaxNumber: | 5082731241 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGHLAND ST STE 209 | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176988184 | ||||||||
| FaxNumber: | 6176986918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 213857 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 213857 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 110007717A | 05 | MA | MEDICAID |