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General NPI Number Information
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NPI Number | 1104885938
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Entity Type | Individual
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Provider Name | CONNELL COVINGTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 3350 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27609-7233
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Country | US
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Telephone | 919-881-9440
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Fax | 919-881-9465
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Provider Business Mailing Address
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Address Line | 7413 SIX FORKS RD # 307
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City | RALEIGH
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State | NC
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Zip | 27615-6164
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Country | US
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Telephone | 919-881-9440
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Fax | 919-881-9465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 22696
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License Number State | NC
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