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General NPI Number Information
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NPI Number | 1942229851
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Entity Type | Individual
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Provider Name | JOHN JOSEPH KOVACICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 217 S INDEPENDENCE AVE
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City | INDEPENDENCE
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State | VA
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Zip | 24348-2802
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Country | US
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Telephone | 276-773-2063
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Fax | 276-773-2118
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Provider Business Mailing Address
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Address Line | 217 S INDEPENDENCE AVE
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City | INDEPENDENCE
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State | VA
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Zip | 24348-2802
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Country | US
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Telephone | 276-773-2063
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Fax | 276-773-2118
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23588
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101038164
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License Number State | VA
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