Provider Demographics
NPI:1487688891
Name:COROVESSIS, CATHERINE C (M D)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:COROVESSIS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 KINGSLAND BLVD, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2545
Mailing Address - Country:US
Mailing Address - Phone:281-398-2140
Mailing Address - Fax:281-398-0017
Practice Address - Street 1:21700 KINGSLAND BLVD, SUITE 203
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2545
Practice Address - Country:US
Practice Address - Phone:281-398-2140
Practice Address - Fax:281-398-0017
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4894207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3627Medicare ID - Type Unspecified
TXH7155Medicare UPIN