Provider Demographics
NPI:1114286747
Name:BOVALINO, JARED CARL (DO)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CARL
Last Name:BOVALINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:2375 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-4203
Practice Address - Country:US
Practice Address - Phone:412-276-1560
Practice Address - Fax:412-276-5805
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2023-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS016857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030072870002Medicaid
PA416271JFZOtherMEDICARE PROVIDER NUMBER