Provider Demographics
NPI:1144406943
Name:GERALD M. KOVAR, M.D. INC.
Entity Type:Organization
Organization Name:GERALD M. KOVAR, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-774-9225
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-774-9225
Mailing Address - Fax:818-774-1261
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-774-9225
Practice Address - Fax:818-774-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90779Medicare UPIN