Provider Demographics
NPI:1073580197
Name:COVICI, STEVEN JARED (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JARED
Last Name:COVICI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1139
Mailing Address - Country:US
Mailing Address - Phone:413-737-7300
Mailing Address - Fax:413-737-7377
Practice Address - Street 1:3640 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1139
Practice Address - Country:US
Practice Address - Phone:413-737-7300
Practice Address - Fax:413-737-7377
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156564207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3176932Medicaid
MA3176932Medicaid
MAA28366Medicare ID - Type Unspecified