Provider Demographics
NPI:1730675117
Name:KOVALEV, DMITRI (MD)
Entity Type:Individual
Prefix:
First Name:DMITRI
Middle Name:
Last Name:KOVALEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 CAMBRIDGE ST. MCNAIR CAMPUS
Mailing Address - Street 2:9TH FLOOR, SUITE 9A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-2273
Mailing Address - Fax:713-798-5339
Practice Address - Street 1:7200 CAMBRIDGE ST. MCNAIR CAMPUS
Practice Address - Street 2:9TH FLOOR, SUITE 9A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-2273
Practice Address - Fax:713-798-5339
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100639032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology