Provider Demographics
NPI:1134128622
Name:COVINGTON, DARELL T (MD)
Entity Type:Individual
Prefix:
First Name:DARELL
Middle Name:T
Last Name:COVINGTON
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 1:500 PLAZA CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8262
Mailing Address - Country:US
Mailing Address - Phone:570-421-8968
Mailing Address - Fax:570-476-1518
Practice Address - Street 1:500 PLAZA CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-421-8968
Practice Address - Fax:570-476-1518
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027319E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73928OtherMEDPLUS PROVIDER NUMBER
PA100001580OtherRR MEDICARE PROVIDER NUMB
PA073753OtherFIRST PRIORITY HEALTH PRO
PA4600007OtherGHI PROVIDER NUMBER
PA5339677OtherCIGNA HEALTHCARE PROVIDER
PA1627622OtherBLUE SHIELD PROVIDER NUMB
PA10521OtherGEISINGER HEALTH PLAN PRO
PA820654OtherAETNA USH PROVIDER NUMBER
PA436110Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER