1609969625 NPI number — ROSE MARIE COVALESKY PA-C

Table of content: ROSE MARIE COVALESKY PA-C (NPI 1609969625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609969625 NPI number — ROSE MARIE COVALESKY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVALESKY
Provider First Name:
ROSE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1609969625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 N BROAD ST
Provider Second Line Business Mailing Address:
3RD FLR CARDIOLOGY CONSULTANTS OF PHILA
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-462-7100
Provider Business Mailing Address Fax Number:
215-463-3820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 S BROAD ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-463-5353
Provider Business Practice Location Address Fax Number:
215-463-8085
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  MA002765L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA002765L . This is a "LICENSE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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