Healthcare Provider Details

I. General information

NPI: 1487843843
Provider Name (Legal Business Name): SUZANNE STEELE COVINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 BLUE RIDGE RD STE 100
RALEIGH NC
27607-6692
US

IV. Provider business mailing address

2406 BLUE RIDGE RD STE 100
RALEIGH NC
27607-6692
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-5001
  • Fax:
Mailing address:
  • Phone: 919-786-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006-01656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: