Provider Demographics
NPI:1861588006
Name:KOVALSKI, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:KOVALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-933-8484
Mailing Address - Fax:610-917-0320
Practice Address - Street 1:826 MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-933-8484
Practice Address - Fax:610-917-0320
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030431E207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
411372Medicare ID - Type Unspecified
PAB41361Medicare UPIN