Provider Demographics
NPI:1114199874
Name:KOVAR, VICKIE L (CR, LMT)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:KOVAR
Suffix:
Gender:F
Credentials:CR, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HEARTHSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-332-4365
Mailing Address - Fax:
Practice Address - Street 1:511 HEARTHSTONE CIRCLE
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-332-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COXXX0000000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA509944311OtherHARTFORD
NJ509944311OtherNJ GUARANTY ASSOCIATION