MEDICARE: DMITRI KOVALEV M.D.

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	2084N0400X	Neurology Physician	89512	SC
2	2084N0400X	Neurology Physician	BP10063903	TX

General Provider Information

NPI Number	:	1730675117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DMITRI KOVALEV M.D.

Provider Business Mailing Address
First Line	:	PO BOX 631341
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 INNOVATION DR STE 350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5269
Country	:	US
Telephone Number	:	864-516-1170
Fax Number	:	877-249-9483

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/24/2024

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Directions to “ DMITRI KOVALEV M.D.” Practice Location

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