Basic Information
| Provider Information | |||||||||
| NPI: | 1790784890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONKOL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1911 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | OWINGS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207369720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102579084 | ||||||||
| FaxNumber: | 3014756169 | ||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | ST. MARY'S HOSPITAL | ||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206500527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014756227 | ||||||||
| FaxNumber: | 3014756169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D21021 | MD | X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | D21021 | MD | X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.