Healthcare Provider Details

I. General information

NPI: 1689649428
Provider Name (Legal Business Name): LINDA J KOVITCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD STREET C/O MA ANESTHESIA CORP
BOSTON MA
02114
US

IV. Provider business mailing address

P.O. BOX 372 C/O MA ANESTHESIA CORP
STOUGHTON MA
02072
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-8600
  • Fax:
Mailing address:
  • Phone: 781-341-3966
  • Fax: 781-341-8269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number173096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: