Healthcare Provider Details

I. General information

NPI: 1861588006
Provider Name (Legal Business Name): RAYMOND KOVALSKI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN STREET SUITE 100
PHOENIXVILLE PA
19460-4478
US

IV. Provider business mailing address

826 MAIN STREET SUITE 100
PHOENIXVILLE PA
19460-4478
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-8484
  • Fax: 610-917-0320
Mailing address:
  • Phone: 610-933-8484
  • Fax: 610-917-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD030431E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD030431E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: