Provider Demographics
NPI:1942458823
Name:KOVACHEV, GEORGI A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGI
Middle Name:A
Last Name:KOVACHEV
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 3370
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-3370
Mailing Address - Country:US
Mailing Address - Phone:985-400-5988
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:664 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1648
Practice Address - Country:US
Practice Address - Phone:985-646-0360
Practice Address - Fax:985-646-0362
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.304447207RN0300X, 207RN0300X
CT53991208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2435256Medicaid
P010103327OtherEXCELLUS BLUE CHOICE
NY03122754Medicaid
255040OtherMVP/PC ROCHESTER AREA LEGACY NUMBER
NYJ400057270Medicare PIN
NY70005AMedicare PIN
NY03122754Medicaid