Healthcare Provider Details

I. General information

NPI: 1306977301
Provider Name (Legal Business Name): SUZAN KOVARICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE #104
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

PO BOX 1479
COLUMBIA MD
21044-0479
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:
Title or Position:
Credential:
Phone: