Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD28306 | SC |
NPI | 1013305259 |
---|---|
Provider Name | Dr. Laura Koniver |
First Address | Haymarket, VA 20169-5439 |
Second Address | Haymarket, VA 20169-5439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |