Provider Demographics
NPI:1801871231
Name:COVELLI CLINIC PA
Entity type:Organization
Organization Name:COVELLI CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-2218
Mailing Address - Street 1:331 N MAITLAND AVENUE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4749
Mailing Address - Country:US
Mailing Address - Phone:407-644-2218
Mailing Address - Fax:407-644-9260
Practice Address - Street 1:331 N MAITLAND AVENUE
Practice Address - Street 2:SUITE C1
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4749
Practice Address - Country:US
Practice Address - Phone:407-644-2218
Practice Address - Fax:407-644-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98180AMedicare PIN