Individual
LEE KONECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 DEKALB PIKE, STE 101, BLUE BELL, PA 19422-1223
(610) 279-7696
(610) 279-7782
Mailing address
207 N. BROAD STREET, 3RD FLOOR, PHILADELPHIA, PA 19107-1500
(215) 462-7100
(215) 463-3820
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD010173E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006943220017
—
PA
Enumeration date
06/17/2005
Last updated
08/15/2011
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