Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 22696 | NC |
NPI | 1104885938 |
---|---|
Provider Name | Mr. Connell Covington |
First Address | Raleigh, NC 27609-7233 |
Second Address | Raleigh, NC 27609-7233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1206226 | UNITED HEALTHCARE (01) | NC |
1539139 | CIGNA (01) | NC |
24752 | BLUE CROSS BLUE SHIELD (01) | NC |
4209043 | AETNA (01) | NC |
8924752 | (05) | NC |
C81034 | (02) | NC |