Provider Demographics
NPI:1639494768
Name:KOVALOVSKY, ANDRA OLIMPIA (MD)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:OLIMPIA
Last Name:KOVALOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDRA
Other - Middle Name:OLIMPIA
Other - Last Name:MARDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1460
Mailing Address - Country:US
Mailing Address - Phone:301-754-7330
Mailing Address - Fax:
Practice Address - Street 1:1500 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1460
Practice Address - Country:US
Practice Address - Phone:301-754-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75749207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology