Provider Demographics
NPI:1124014006
Name:KOVACS, STEPHEN O (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:O
Last Name:KOVACS
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Gender:M
Credentials:MD
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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:SUITE 302
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-787-0400
Practice Address - Fax:617-500-0976
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-01-07
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Provider Licenses
StateLicense IDTaxonomies
MA208808207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051131Medicaid
MA051131Medicaid