Provider Demographics
NPI:1396733218
Name:GUERRIERE-KOVACH, PAMELA (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GUERRIERE-KOVACH
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 1:5208 MAHONING AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1859
Mailing Address - Country:US
Mailing Address - Phone:330-799-9270
Mailing Address - Fax:330-799-2295
Practice Address - Street 1:5208 MAHONING AVE STE 208
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1859
Practice Address - Country:US
Practice Address - Phone:330-799-9270
Practice Address - Fax:330-799-2295
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074029G174400000X
WV20881207ZD0900X
VA0101231016207ZD0900X
FLME84498207ZD0900X
PAMD418830207ZD0900X
OH35074029207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7910405OtherAETNA
OH300177497002OtherMEDICAL MUTUAL
OH000000285461OtherANTHEM
OH000000282926OtherANTHEM BCBS
WV6703070000Medicaid
OH1101310OtherUNITED HEALTHCARE
OH2407818Medicaid
OH341952521003OtherMEDICAL MUTUAL
VA010128099Medicaid
OH300177497OtherUNITED
OHH71261Medicare UPIN
OH000000285461OtherANTHEM
OHP00027015Medicare ID - Type UnspecifiedRAILROAD MEDICARE