Provider Demographics
NPI:1316906258
Name:KOVALSKI, ADAM E (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:E
Last Name:KOVALSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1646
Mailing Address - Country:US
Mailing Address - Phone:860-696-2200
Mailing Address - Fax:860-561-7272
Practice Address - Street 1:445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1646
Practice Address - Country:US
Practice Address - Phone:860-696-2200
Practice Address - Fax:860-561-7272
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316906258OtherNPI
Q05698Medicare UPIN
1316906258OtherNPI