Basic Information
| Provider Information | |||||||||
| NPI: | 1043630502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DZIAMSKI | ||||||||
| FirstName: | KONRAD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 292 SAINT CHARLES WAY | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516236 | ||||||||
| FaxNumber: | 7177411614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101275460 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 0101275460 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | MD466766 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.