Provider Demographics
NPI:1679728307
Name:COVILLE, FREDERICK A (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:COVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEW RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1200
Mailing Address - Country:US
Mailing Address - Phone:609-957-5652
Mailing Address - Fax:
Practice Address - Street 1:401 NEW RD STE 103
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1200
Practice Address - Country:US
Practice Address - Phone:609-957-5652
Practice Address - Fax:609-365-2897
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05499900207N00000X, 208200000X, 2086S0122X
NJ25MAO54999000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice