Basic Information
| Provider Information | |||||||||
| NPI: | 1437334497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST MARY'S HOSPITAL PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 632828 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212632828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018486480 | ||||||||
| FaxNumber: | 3018430324 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT ROAD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014756227 | ||||||||
| FaxNumber: | 3014756169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | KONKOL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 3014756227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.