Provider Demographics
NPI:1821074741
Name:KOVACH, CORIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORIE
Middle Name:LYNN
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ST LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8310
Mailing Address - Country:US
Mailing Address - Phone:419-455-7000
Mailing Address - Fax:419-455-7227
Practice Address - Street 1:45 ST LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8310
Practice Address - Country:US
Practice Address - Phone:419-455-7000
Practice Address - Fax:419-455-7227
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2070002Medicaid
OH2070002Medicaid
OH2070002Medicaid
OHG82281Medicare UPIN
OHH302170Medicare PIN
OH3025372Medicaid