Provider Demographics
NPI:1689649428
Name:KOVITCH, LINDA J (CRNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:KOVITCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 372
Mailing Address - Street 2:C/O MA ANESTHESIA CORP
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:781-341-8269
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:C/O MA ANESTHESIA CORP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:508-746-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173096367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0518OtherBLUE CROSS OF MA
MANA0518OtherBLUE CROSS OF MA
MAP00258889Medicare ID - Type UnspecifiedRAILROAD MEDICARE