Provider Demographics
NPI:1104885938
Name:COVINGTON, CONNELL (MD)
Entity type:Individual
Prefix:MR
First Name:CONNELL
Middle Name:
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 1:7413 SIX FORKS RD # 307
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6164
Mailing Address - Country:US
Mailing Address - Phone:919-881-9440
Mailing Address - Fax:919-881-9465
Practice Address - Street 1:3350 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7233
Practice Address - Country:US
Practice Address - Phone:919-881-9440
Practice Address - Fax:919-881-9465
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226962080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1206226OtherUNITED HEALTHCARE
NC1539139OtherCIGNA
NC4209043OtherAETNA
NC8924752Medicaid
NC24752OtherBLUE CROSS BLUE SHIELD
NC4209043OtherAETNA