Provider Demographics
NPI:1316265408
Name:FREDERICK A. COVILLE, MD, PC
Entity type:Organization
Organization Name:FREDERICK A. COVILLE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:COVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-957-5652
Mailing Address - Street 1:255 NORTHPOINT ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226
Mailing Address - Country:US
Mailing Address - Phone:609-957-5652
Mailing Address - Fax:609-952-6082
Practice Address - Street 1:301 CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8340
Practice Address - Country:US
Practice Address - Phone:609-957-5652
Practice Address - Fax:609-952-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05499900207N00000X, 208200000X, 208D00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty