=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790013043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARELL COVINGTON, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2009
-----------------------------------------------------
Last Update Date | 11/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 PLAZA CT SUITE C
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-421-8968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 PLAZA CT SUITE C
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-421-8968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DARELL T COVINGTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 570-421-8968
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD027319E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------