Healthcare Provider Details

I. General information

NPI: 1447493101
Provider Name (Legal Business Name): KELLEY ZAGOL KOVATIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY JANE ZAGOL

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5202
  • Fax: 215-427-8192
Mailing address:
  • Phone: 484-628-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD445944
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD445944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: