MEDICARE: MR. RONALD JAMES KOVACEVIC CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN500488L	PA

General Provider Information

NPI Number	:	1154682540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD JAMES KOVACEVIC CRNA

Provider Business Mailing Address
First Line	:	282 LOUTHAN RD
Second Line	:
City	:	DARLINGTON
State	:	PA
Zip	:	16115-3518
Country	:	US
Telephone Number	:	724-827-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 REEDSDALE ST
Second Line	:	SUITE 4004
City	:	PITTSBURGH
State	:	PA
Zip	:	15233-2341
Country	:	US
Telephone Number	:	412-204-0048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2012
Last Update Date	:	06/03/2012

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