Healthcare Provider Details

I. General information

NPI: 1306022033
Provider Name (Legal Business Name): SUZAN KOVARICK M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE SUITE #104
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

8218 WISCONSIN AVE STE 104
BETHESDA MD
20814-3107
US

V. Phone/Fax

Practice location:
  • Phone: 301-654-9460
  • Fax: 301-654-9461
Mailing address:
  • Phone: 301-654-9460
  • Fax: 301-654-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0028183
License Number StateMD

VIII. Authorized Official

Name: DR. SUZAN KOVARICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-654-9460