1184785859 NPI number — PETER KOVACS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184785859 NPI number — PETER KOVACS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KOVACS

Provider First Name:

PETER

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1184785859

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/10/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1219 WALTER REED RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FAYETTEVILLE

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

28304-4437

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

910-615-3350

Provider Business Mailing Address Fax Number:

910-321-6253

Provider First Line Business Practice Location Address:

1219 WALTER REED RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FAYETTEVILLE

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28304-4437

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

910-615-3350

Provider Business Practice Location Address Fax Number:

910-321-6253

Provider Enumeration Date:

12/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084N0400X , with the licence number:  234548 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: 2010-01733 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 02644604 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 110404000053 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "NOVA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 0512831 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "NORTH AMERICAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1184785859 . This is a "GHI" identifier . This identifiers is of the category "OTHER".