Provider Demographics
NPI:1811213929
Name:KOVALCHIK, LAUREN KOSTELNIK
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KOSTELNIK
Last Name:KOVALCHIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MARTINS LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5854
Mailing Address - Country:US
Mailing Address - Phone:610-357-4925
Mailing Address - Fax:
Practice Address - Street 1:1304 LAUREL OAK RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4310
Practice Address - Country:US
Practice Address - Phone:888-873-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12497000208000000X
PAMD448445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics