Provider Demographics
NPI:1417994476
Name:KOVALCHIN, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KOVALCHIN
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 1:700 CHILDREN'S DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-3100
Mailing Address - Fax:614-722-2549
Practice Address - Street 1:700 CHILDREN'S DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-3100
Practice Address - Fax:614-722-2549
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350601662080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3810006450OtherWV MEDICAID
OHKO4189282OtherMEDICARE
OH64128010OtherKY MEDICAID
OH0872604Medicaid
OHKO4189281OtherMEDICARE OHIO
OH3810006450OtherWV MEDICAID