Provider Demographics
NPI:1184785859
Name:KOVACS, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KOVACS
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 1:1219 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4437
Mailing Address - Country:US
Mailing Address - Phone:910-615-3350
Mailing Address - Fax:910-321-6253
Practice Address - Street 1:1219 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4437
Practice Address - Country:US
Practice Address - Phone:910-615-3350
Practice Address - Fax:910-321-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2345482084N0400X
NC2010-017332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02644604Medicaid
110404000053OtherFIDELIS
1184785859OtherNOVA
1184785859OtherEMPIRE
1184785859OtherAETNA
NY0512831OtherINDEPENDENT HEALTH
1184785859OtherNORTH AMERICAN
1184785859OtherBLUE CROSS
NY1184785859OtherUNIVERA
1184785859OtherTRICARE
NY1184785859OtherHUMANA
1184785859OtherGHI
NYG36732Medicare UPIN