Healthcare Provider Details

I. General information

NPI: 1770778672
Provider Name (Legal Business Name): ERIE SHORE WOMENS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5054 WATERFORD PLACE DR
ELYRIA OH
44035
US

IV. Provider business mailing address

524 CLEVELAND ST
ELYRIA OH
44035-4055
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-8344
  • Fax:
Mailing address:
  • Phone: 440-934-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORIE L KOVACH
Title or Position: OWNER
Credential: MD
Phone: 440-934-8344