Provider Demographics
NPI:1033452917
Name:STEPHEN OTTO KOVACS
Entity Type:Organization
Organization Name:STEPHEN OTTO KOVACS
Other - Org Name:STEPHEN O KOVACS, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-787-0400
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:STE 353
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-787-0400
Mailing Address - Fax:617-500-0976
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:STE 353
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-787-0400
Practice Address - Fax:617-500-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208808207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty