Provider Demographics
NPI:1255452413
Name:DR PAUL J KOVALCIK M.D. LTD
Entity type:Organization
Organization Name:DR PAUL J KOVALCIK M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:KOVALCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-686-2687
Mailing Address - Street 1:3105 AMERICAN LEGION ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5653
Mailing Address - Country:US
Mailing Address - Phone:757-686-2687
Mailing Address - Fax:757-484-1682
Practice Address - Street 1:3105 AMERICAN LEGION RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5654
Practice Address - Country:US
Practice Address - Phone:757-686-2687
Practice Address - Fax:757-484-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty