Healthcare Provider Details

I. General information

NPI: 1164048013
Provider Name (Legal Business Name): GABRIELA KOVACIKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MEDICAL CENTER DR STE 1300
BRUNSWICK ME
04011-2765
US

IV. Provider business mailing address

81 MEDICAL CENTER DR STE 1300
BRUNSWICK ME
04011-2765
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-8333
  • Fax: 207-618-5670
Mailing address:
  • Phone: 207-721-8333
  • Fax: 207-618-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74536
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP05095
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30020
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: