Provider Demographics
NPI:1558312272
Name:KOVICH, OLYMPIA (MD)
Entity Type:Individual
Prefix:
First Name:OLYMPIA
Middle Name:
Last Name:KOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLYMPIA
Other - Middle Name:I
Other - Last Name:SZLAKOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-316-7470
Mailing Address - Fax:508-316-7471
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-316-7470
Practice Address - Fax:508-316-7471
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227842207ND0900X
MA249824207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090517AMedicaid