Provider Demographics
NPI:1518932466
Name:COVINGTON, HENRY C (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602A CANTON ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1924
Mailing Address - Country:US
Mailing Address - Phone:270-886-1773
Mailing Address - Fax:270-886-2992
Practice Address - Street 1:1602A CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1924
Practice Address - Country:US
Practice Address - Phone:270-886-1773
Practice Address - Fax:270-886-2992
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64032394Medicaid
KY64032394Medicaid
KY0930601Medicare ID - Type Unspecified