Provider Demographics
NPI:1013913979
Name:COVA, JENNIFER L (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:COVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:DECAESTECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:896 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3439
Mailing Address - Country:US
Mailing Address - Phone:937-433-6513
Mailing Address - Fax:937-291-3398
Practice Address - Street 1:896 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3439
Practice Address - Country:US
Practice Address - Phone:937-433-6513
Practice Address - Fax:937-291-3398
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479241Medicaid
OHH199541OtherMEDICARE PTAN
OH2479241Medicaid
OH2981431OtherAETNA US HEALTHCARE
OH7378007005OtherCIGNA
OH4087125Medicare PIN
OH000000224417OtherANTHEM BENEFIT ADMINISTRA
OH07858OtherCHOICECARE
OH160056622OtherRAILROAD MEDICARE-PALMETT
OHH12181Medicare UPIN