Provider Demographics
NPI:1225104169
Name:KOVAC, CHRISTINE MOTRIA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MOTRIA
Last Name:KOVAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:BERRY BLDG, GROUND FL
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-2516
Mailing Address - Fax:937-208-6124
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:BERRY BLDG, GROUND FL
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2516
Practice Address - Fax:937-208-6124
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091731207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2824171Medicaid
OHH022010Medicare PIN
OH4237571Medicare PIN