Provider Demographics
NPI:1255391744
Name:KOVACS, CHARMAINE M (CRNA)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:M
Last Name:KOVACS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:M
Other - Last Name:SHARAF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5114 LADORA WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1828
Mailing Address - Country:US
Mailing Address - Phone:412-708-6259
Mailing Address - Fax:
Practice Address - Street 1:5114 LADORA WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1828
Practice Address - Country:US
Practice Address - Phone:412-708-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122766367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405598500Medicaid
MD405598500Medicaid