Healthcare Provider Details

I. General information

NPI: 1801126289
Provider Name (Legal Business Name): DANIEL MICHAEL COVITZ IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 BALLAHACK RD. STE 100 CAPT W.L. MCGONAGLE BRANCH CLINIC NSA NORTHWEST
CHESAPEAKE VA
23322-2463
US

IV. Provider business mailing address

1317 BALLAHACK RD. STE 100 CAPT W.L. MCGONAGLE BRANCH CLINIC NSA NORTHWEST
CHESAPEAKE VA
23322-2463
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-6259
  • Fax:
Mailing address:
  • Phone: 757-953-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: