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General NPI Number Information
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NPI Number | 1962815191
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Entity Type | Individual
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Provider Name | KEVIN JOHN KOVATCH MD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVENUE
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City | FARMINGTON
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State | CT
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Zip | 06030
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Country | US
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Telephone | 860-679-2804
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Fax | 860-679-1179
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-8082
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Country | US
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Telephone | 860-679-2804
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Fax | 860-679-1179
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 61020
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD474008
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301105770
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 080595
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License Number State | CT
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