=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427035633
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN R KOVAL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 08/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 AFRICA RD STE 340
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-901-2273
-----------------------------------------------------
Fax | 614-901-3140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 AFRICA RD STE 340
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-9808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-901-2273
-----------------------------------------------------
Fax | 614-901-3140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35-05-9244
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------