Provider Demographics
NPI:1972680106
Name:COVELLI, CHRISTINA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RUTH
Last Name:COVELLI
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 1:3345 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5220
Mailing Address - Country:US
Mailing Address - Phone:352-742-2192
Mailing Address - Fax:352-742-2689
Practice Address - Street 1:3345 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5220
Practice Address - Country:US
Practice Address - Phone:352-742-2192
Practice Address - Fax:352-742-2689
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109150207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003843600Medicaid
ALDF6813OtherRAIL ROAD MEDICARE GROUP #
AL1922129618OtherALABAMA LIVER & DIGESTIVE SPECIALISTS ORGANIZATIONAL GROUP NPI
AL203204949OtherTAX EID #
AL25647OtherALABAMA MEDICAL LISCENSE
AL529932823Medicaid
AL25647OtherALABAMA MEDICAL LISCENSE