Provider Demographics
NPI:1194726000
Name:BRINGMAN, KONNI ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:KONNI
Middle Name:ELAINE
Last Name:BRINGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:4201 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3163
Practice Address - Country:US
Practice Address - Phone:301-262-5900
Practice Address - Fax:410-741-0865
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0051169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5368532OtherAETNA FEE FOR SERVICE
MD7605-0005OtherCAREFIRST BLUECHOICE
MD807800900Medicaid
MD034261OtherJHHC PROVIDER NUMBER
MD851458OtherMAMSI PRIMARY CARE
MD54608401OtherCAREFIRST MD RENDERING
MD251458OtherMAMSI SPECIALIST
MD0961354OtherAETNA CAPITATED
MD80151855OtherRAILROAD MEDICARE
MD5924717OtherCIGNA PIN
MDP13928OtherCAREFIRST MPOS
MDG00114000F22M14Medicare PIN
MD851458OtherMAMSI PRIMARY CARE