Healthcare Provider Details

I. General information

NPI: 1811395585
Provider Name (Legal Business Name): COVE CREEK EMERGENCY PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

PO BOX 930
SAN DIMAS CA
91773-0930
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-1100
  • Fax: 276-258-1125
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-447-0296