Provider Demographics
NPI:1386619625
Name:KOENIG, TERESA (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:STE. 1B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1423
Mailing Address - Country:US
Mailing Address - Phone:330-375-3315
Mailing Address - Fax:330-375-3760
Practice Address - Street 1:55 ARCH ST
Practice Address - Street 2:STE. 1B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1423
Practice Address - Country:US
Practice Address - Phone:330-375-3315
Practice Address - Fax:330-375-3760
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773463OtherMEDICARE ID
OH110146643OtherRAILROAD MEDICARE
OH04-03134OtherUNITED HEALTHCARE
OH0773461OtherMEDICARE ID
OH088OtherSUMMA
OH729118OtherBUCKEYE COMMUNITY HEALTH
OH0723739Medicaid
OH000000132169OtherANTHEM
OH110146643OtherRAILROAD MEDICARE