Healthcare Provider Details

I. General information

NPI: 1922307404
Provider Name (Legal Business Name): KELLY A COVEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

PO BOX 72384
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-2842
  • Fax: 330-580-5536
Mailing address:
  • Phone: 330-363-2842
  • Fax: 330-580-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.127773
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: