Provider Demographics
NPI:1891806311
Name:COVINGTON, BENJAMIN G (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:COVINGTON
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:PO BOX 30220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90030-0220
Mailing Address - Country:US
Mailing Address - Phone:562-803-0124
Mailing Address - Fax:562-803-5569
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-803-0124
Practice Address - Fax:562-803-5569
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG691952085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF93774Medicare UPIN
CAWG69195AMedicare PIN