Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD009611E | PA |
Y | 208600000X | Surgeon | MD009611E | PA |
NPI | 1003156381 |
---|---|
Provider Name | Dr. Carl W Konvolinka |
First Address | Johnstown, PA 15905-5106 |
Second Address | Johnstown, PA 15905-5106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 22/02/2013 |