Healthcare Provider Details

I. General information

NPI: 1417254186
Provider Name (Legal Business Name): STEPHEN O KOVACS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST SUITE# 307
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

77 WARREN ST SUITE# 353
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 508-820-0700
  • Fax: 508-809-3804
Mailing address:
  • Phone: 617-787-0400
  • Fax: 617-500-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number208808
License Number StateMA

VIII. Authorized Official

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