Provider Demographics
NPI:1417254186
Name:STEPHEN O KOVACS MD PC
Entity Type:Organization
Organization Name:STEPHEN O KOVACS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-787-0400
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:SUITE# 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 1:61 LINCOLN ST
Practice Address - Street 2:SUITE# 307
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-820-0700
Practice Address - Fax:508-809-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208808207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11007489AMedicaid
MAF54388Medicare UPIN
MA11007489AMedicaid