Healthcare Provider Details

I. General information

NPI: 1144228701
Provider Name (Legal Business Name): ANTHONY LOUIS KOVATCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9795 PERRY HWY
WEXFORD PA
15090-9700
US

IV. Provider business mailing address

9795 PERRY HWY SUITE 100
WEXFORD PA
15090-9700
US

V. Phone/Fax

Practice location:
  • Phone: 412-366-7337
  • Fax: 412-366-5118
Mailing address:
  • Phone: 412-366-7337
  • Fax: 412-366-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD025469E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0009047510009
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: