Provider Demographics
NPI:1679798375
Name:KOVACHY, EDWARD MIKLOS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MIKLOS
Last Name:KOVACHY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1187 UNIVERSITY DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4423
Mailing Address - Country:US
Mailing Address - Phone:650-329-0600
Mailing Address - Fax:650-329-0459
Practice Address - Street 1:1187 UNIVERSITY DR
Practice Address - Street 2:SUITE #6
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4423
Practice Address - Country:US
Practice Address - Phone:650-329-0600
Practice Address - Fax:650-329-0459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG367882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G36880Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID