MATTHEW MONDHOL KONGKATONG
Controlled Substance Registration for Practitioner


Address: 1053 Tupelo Ct, Charlottesville, VA 22903-7895

MATTHEW MONDHOL KONGKATONG (Credential# 1473135) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.

Business Overview

MATTHEW MONDHOL KONGKATONG is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0067389. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 1053 Tupelo Ct, Charlottesville, VA 22903-7895. The current status is active.

Basic Information

Licensee Name MATTHEW MONDHOL KONGKATONG
Credential ID 1473135
Credential Number CSP.0067389
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 1053 Tupelo Ct
Charlottesville
VA 22903-7895
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2018-03-02
Effective Date 2019-03-01
Expiration Date 2021-02-28
Refresh Date 2018-12-27

Other licenses

ID Credential Code Credential Type Issue Term Status
1471745 1.060105 Physician/Surgeon 2018-03-02 2019-02-01 - 2020-01-31 ACTIVE

Office Location

Street Address 1053 TUPELO CT
City CHARLOTTESVILLE
State VA
Zip Code 22903-7895

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Erin M Morrell 1830 Candlewood Court, Charlottesville, VA 22903 Registered Nurse 2019-08-01 ~ 2020-07-31
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Competitor

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City CHARLOTTESVILLE
Zip Code 22903
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + CHARLOTTESVILLE

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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