Provider Demographics
NPI:1629170246
Name:COVINGTON, JOHN ASHBY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ASHBY
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 BELLONA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5465
Mailing Address - Country:US
Mailing Address - Phone:410-583-0300
Mailing Address - Fax:410-583-0306
Practice Address - Street 1:1300 BELLONA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5465
Practice Address - Country:US
Practice Address - Phone:410-583-0300
Practice Address - Fax:410-583-0306
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025910174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332631400Medicaid
MD332631400Medicaid
D73760Medicare UPIN