Provider Demographics
NPI:1417059064
Name:KOVAL, MAUREEN A (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:KOVAL
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 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-520-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8193534Medicaid
7632KOOtherREGENCE
3233454OtherCIGNA
5182590OtherAETNA
P00474866OtherRAILROAD MEDICARE
BK4232752OtherDEA
3233454OtherCIGNA
G8869651Medicare PIN
G8873977Medicare PIN
7632KOOtherREGENCE
G8868594Medicare PIN
F93851Medicare UPIN