Individual
ANITA KONKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-4660
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-4660
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD456357
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012377200
—
FL
01
—
14V4A
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/23/2009
Last updated
11/03/2015
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