Healthcare Provider Details

I. General information

NPI: 1396733218
Provider Name (Legal Business Name): PAMELA GUERRIERE-KOVACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 MAHONING AVE STE 208
YOUNGSTOWN OH
44515-1859
US

IV. Provider business mailing address

5208 MAHONING AVE STE 208
YOUNGSTOWN OH
44515-1859
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-9270
  • Fax: 330-799-2295
Mailing address:
  • Phone: 330-799-9270
  • Fax: 330-799-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35074029G
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number20881
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number0101231016
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME84498
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD418830
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number35074029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: