Provider Demographics
NPI:1669409686
Name:KONOPKA, SCOTT E (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:KONOPKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:919-562-2288
Mailing Address - Fax:919-562-2225
Practice Address - Street 1:3213 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3805
Practice Address - Country:US
Practice Address - Phone:919-562-2288
Practice Address - Fax:919-562-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200300165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913713Medicaid
NC8913713Medicaid