Provider Demographics
NPI:1578633293
Name:KOVAC, MAGDALENA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:KOVAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9058 LAWNDELL SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662
Mailing Address - Country:US
Mailing Address - Phone:330-879-5555
Mailing Address - Fax:330-879-2243
Practice Address - Street 1:24 CECIL ST NE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662
Practice Address - Country:US
Practice Address - Phone:330-879-2243
Practice Address - Fax:330-879-2243
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039368208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338334Medicaid
OH0338334Medicaid
K00437583Medicare ID - Type Unspecified