Basic Information
| Provider Information | |||||||||
| NPI: | 1194726000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINGMAN | ||||||||
| FirstName: | KONNI | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 MITCHELLVILLE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012625900 | ||||||||
| FaxNumber: | 4107410865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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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 | 207Q00000X | D0051169 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5368532 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | 7605-0005 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 807800900 | 05 | MD | MEDICAID | 034261 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 851458 | 01 | MD | MAMSI PRIMARY CARE | OTHER | 54608401 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 251458 | 01 | MD | MAMSI SPECIALIST | OTHER | 0961354 | 01 | MD | AETNA CAPITATED | OTHER | 80151855 | 01 | MD | RAILROAD MEDICARE | OTHER | 5924717 | 01 | MD | CIGNA PIN | OTHER | P13928 | 01 | MD | CAREFIRST MPOS | OTHER |