Provider Demographics
NPI:1770778672
Name:ERIE SHORE WOMENS HEALTH
Entity type:Organization
Organization Name:ERIE SHORE WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-934-8344
Mailing Address - Street 1:524 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4055
Mailing Address - Country:US
Mailing Address - Phone:440-934-8344
Mailing Address - Fax:
Practice Address - Street 1:5054 WATERFORD PLACE DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-934-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2637721Medicaid
OHDF0746OtherPALMETTO GBA RETIRED
OH000000387553OtherANTHEM BLUE CROSS
OH9359801Medicare PIN