Provider Demographics
NPI:1982670055
Name:COVERDALE, JANICE N (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:N
Last Name:COVERDALE
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0069
Mailing Address - Country:US
Mailing Address - Phone:828-649-9566
Mailing Address - Fax:828-649-3786
Practice Address - Street 1:590 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6807
Practice Address - Country:US
Practice Address - Phone:828-649-3500
Practice Address - Fax:828-649-1032
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8924736Medicaid
NCC87428Medicare UPIN
NC8924736Medicaid