Basic Information
Provider Information
NPI: 1003156381
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KONVOLINKA
FirstName: CARL
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3987 MENOHER BLVD
Address2:  
City: JOHNSTOWN
State: PA
PostalCode: 159055106
CountryCode: US
TelephoneNumber: 8142540050
FaxNumber:  
Practice Location
Address1: 3987 MENOHER BLVD
Address2:  
City: JOHNSTOWN
State: PA
PostalCode: 159055106
CountryCode: US
TelephoneNumber: 8142540050
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2013
LastUpdateDate: 02/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMD009611EPAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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