Provider Demographics
NPI:1396926614
Name:STEPHEN O. KOVACS MD PC
Entity type:Organization
Organization Name:STEPHEN O. KOVACS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-787-0400
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:SUITE# 353
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:617-500-0976
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:SUITE# 353
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-787-0400
Practice Address - Fax:617-500-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21542Medicare PIN