Provider Information for 1619972395
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JONATHAN COVAULT MD
Sex: Male
NPI: 1619972395
Last Updated: 2022-09-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
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| NPI | 1619972395 | ||||||||||||||
| Enumeration Date | 2005-06-17 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE PROVIDER ENROLLMENT FARMINGTON, CT 06030-2212 United States Phone: 860-679-7503 | Fax:860-679-1610 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-6410 United States Phone: 860-679-6703 | Fax:860-679-1296 | ||||||||||||||
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