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General NPI Number Information
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NPI Number | 1417254186
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Entity Type | Organization
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Legal Business Name | STEPHEN O KOVACS MD PC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 61 LINCOLN ST SUITE# 307
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City | FRAMINGHAM
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State | MA
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Zip | 01702-8264
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Country | US
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Telephone | 508-820-0700
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Fax | 508-809-3804
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Provider Business Mailing Address
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Address Line | 77 WARREN ST SUITE# 353
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City | BRIGHTON
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State | MA
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Zip | 02135-3601
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Country | US
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Telephone | 617-787-0400
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Fax | 617-500-0976
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN O KOVACS
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Credential | MD
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Telephone | 617-787-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 208808
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License Number State | MA
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