Provider Demographics
NPI:1427035633
Name:KOVAL, ANN R (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:R
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 1:625 AFRICA RD STE 340
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-901-2273
Mailing Address - Fax:614-901-3140
Practice Address - Street 1:625 AFRICA RD STE 340
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-901-2273
Practice Address - Fax:614-901-3140
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0799051Medicaid
OH0679888Medicare PIN
OH0799051Medicaid