Healthcare Provider Details

I. General information

NPI: 1962628149
Provider Name (Legal Business Name): DEMETRIA MICHELLE COVERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N TWIN CIRCLE WAY
BALTIMORE MD
21227
US

IV. Provider business mailing address

19 N TWIN CIRCLE WAY
BALTIMORE MD
21227
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-1014
  • Fax:
Mailing address:
  • Phone: 410-636-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00022067
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: