1760505135 NPI number — STEPHANIE STERRETT KONKUS M.D.

Table of content: STEPHANIE STERRETT KONKUS M.D. (NPI 1760505135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760505135 NPI number — STEPHANIE STERRETT KONKUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONKUS
Provider First Name:
STEPHANIE
Provider Middle Name:
STERRETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STERRETT
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760505135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TOWN PEDIATRICS
Provider Second Line Business Mailing Address:
823 S. KING ST
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-777-5222
Provider Business Mailing Address Fax Number:
703-777-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TOWN PEDIATRICS
Provider Second Line Business Practice Location Address:
823 S. KING ST
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-777-5222
Provider Business Practice Location Address Fax Number:
703-777-5144
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD431289 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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