Provider Demographics
NPI:1346462280
Name:CHOVAN, FRED A (MED)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:A
Last Name:CHOVAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1842
Mailing Address - Country:US
Mailing Address - Phone:814-453-7661
Mailing Address - Fax:814-455-1132
Practice Address - Street 1:136 EAST AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1842
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-455-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003265-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001880799 0001Medicaid