Healthcare Provider Details

I. General information

NPI: 1992773451
Provider Name (Legal Business Name): JOHN M KOVAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7641 MARKET ST STE 2
YOUNGSTOWN OH
44512-5980
US

IV. Provider business mailing address

7629 MARKET ST STE 200
YOUNGSTOWN OH
44512-6082
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-2444
  • Fax: 330-965-4836
Mailing address:
  • Phone: 330-965-4540
  • Fax: 330-965-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35048160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: