Healthcare Provider Details

I. General information

NPI: 1669492146
Provider Name (Legal Business Name): NICHOLAS L KOVACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 230
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

PO BOX 84088
SEATTLE WA
98124-8488
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-2148
  • Fax: 425-990-5261
Mailing address:
  • Phone: 425-454-5281
  • Fax: 425-454-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00024713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: