Basic Information
| Provider Information | |||||||||
| NPI: | 1336140748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONICK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JAY | ||||||||
| 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: | 125 SHOREWAY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | QUEENSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216581666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108274001 | ||||||||
| FaxNumber: | 4108274333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 05/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0032353 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 248738 | 01 | MD | MAMSI SPECIALIST | OTHER | 159031600 | 05 | MD | MEDICAID | 529991-06 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 7605-0043 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 848738 | 01 | MD | MAMSI PRIMARY CARE | OTHER | 3086076 | 01 | MD | CIGNA PIN | OTHER | 5360473 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | 0927385 | 01 | MD | AETNA CAPITATED | OTHER | 032388 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | P12855 | 01 | MD | CAREFIRST MPOS | OTHER | 110183169 | 01 | MD | RR MEDICARE | OTHER |