Provider Demographics
NPI:1942229851
Name:KOVACICH, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:KOVACICH
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 1:217 S INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-2802
Mailing Address - Country:US
Mailing Address - Phone:276-773-2063
Mailing Address - Fax:276-773-2118
Practice Address - Street 1:217 S INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-2802
Practice Address - Country:US
Practice Address - Phone:276-773-2063
Practice Address - Fax:276-773-2118
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23588207R00000X
VA0101038164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0918873OtherUNITED MINE WORKERS
NC34DO247236OtherCLIA
NC161810OtherBLACK LUNG
VA224035OtherANTHEM
NC50294OtherBLUE CROSS BLUE SHIELD
VA6084656Medicaid
NCPARTNERSOtherPARTNERS
VA074399OtherBLUE CROSS AND BLUE SHIEL
NC5891172OtherAETNA
NC833463OtherFIRST HEALTH
NC8950294Medicaid
NC04-07535OtherUNITED HEALTHCARE
NC110133872OtherRAILROAD MEDICARE
NC5891172OtherAETNA
NCC81104Medicare UPIN
NC8950294Medicaid