Provider Demographics
NPI:1194733279
Name:KOVACH, PAUL ANTON (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTON
Last Name:KOVACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5775 N MEADOWS DR STE D
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7300
Mailing Address - Country:US
Mailing Address - Phone:614-224-4200
Mailing Address - Fax:614-224-4207
Practice Address - Street 1:5775 N MEADOWS DR STE D
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7300
Practice Address - Country:US
Practice Address - Phone:614-224-4200
Practice Address - Fax:614-224-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087058207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.087058OtherSTATE MEDICAL LICENSE
OH2645301Medicaid
I51581Medicare UPIN
OHKO4180801Medicare PIN
OHKO4180802Medicare PIN