Provider Demographics
NPI:1861501736
Name:AUSTIN DERMATOLOGY CLINIC, PA
Entity Type:Organization
Organization Name:AUSTIN DERMATOLOGY CLINIC, PA
Other - Org Name:MICHAEL H. COVERMAN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:COVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-345-9411
Mailing Address - Street 1:11623 ANGUS RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4041
Mailing Address - Country:US
Mailing Address - Phone:512-345-9411
Mailing Address - Fax:512-345-0392
Practice Address - Street 1:11623 ANGUS RD
Practice Address - Street 2:SUITE 25
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4041
Practice Address - Country:US
Practice Address - Phone:512-345-9411
Practice Address - Fax:512-345-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF6572OtherRAILROAD MEDICARE
TX0096PMOtherBLUE CROSS BLUE SHIELD
TX0096PMOtherBLUE CROSS BLUE SHIELD