Healthcare Provider Details

I. General information

NPI: 1396926614
Provider Name (Legal Business Name): STEPHEN O. KOVACS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST SUITE# 353
BRIGHTON MA
02135
US

IV. Provider business mailing address

77 WARREN ST SUITE# 353
BRIGHTON MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 617-787-0400
  • Fax: 617-500-0976
Mailing address:
  • Phone:
  • Fax: 617-500-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN O KOVACS
Title or Position: OWNER
Credential: MD
Phone: 617-787-0400