Provider Demographics
NPI:1588673909
Name:KOVANKO, ALEXANDER P (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:KOVANKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BIRCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2752
Mailing Address - Country:US
Mailing Address - Phone:603-421-9616
Mailing Address - Fax:603-421-2451
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-421-9616
Practice Address - Fax:603-421-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1920207Q00000X
NH16416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3095269Medicaid
NHP01303747OtherRAILROAD MEDICARE
NHT400121299Medicare PIN
NH3095269Medicaid