Provider Demographics
NPI:1619947553
Name:COVALESKY, VERONICA A (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:A
Last Name:COVALESKY
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 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-463-5333
Mailing Address - Fax:215-463-8085
Practice Address - Street 1:1703 S BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-463-5333
Practice Address - Fax:215-463-8085
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039820L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011304760004Medicaid
PA406938GT6Medicare PIN