Provider Demographics
NPI:1790013043
Name:DARELL COVINGTON, M.D., P.C.
Entity Type:Organization
Organization Name:DARELL COVINGTON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-421-8968
Mailing Address - Street 1:500 PLAZA CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8262
Mailing Address - Country:US
Mailing Address - Phone:570-421-8968
Mailing Address - Fax:
Practice Address - Street 1:500 PLAZA CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-421-8968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027319E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41803Medicare UPIN
PA436110Medicare PIN