Provider Demographics
NPI:1306977301
Name:KOVARICK, SUZAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:
Last Name:KOVARICK
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 1479
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0479
Mailing Address - Country:US
Mailing Address - Phone:301-654-9460
Mailing Address - Fax:301-654-9461
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:#104
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-654-9460
Practice Address - Fax:301-654-9461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028183207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC437843Medicare ID - Type UnspecifiedPROVIDER NUMBER
DCD09614Medicare UPIN