Individual provider Active NPI

Carol J Kovanda, MD

  • Obstetrics & Gynecology Physician
  • Tacoma, WA
National Provider Identifier
1487654448
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD00021017 Issued in WA
Practice address
314 Martin Luther King Jr Way
Ste 104
Tacoma, WA 98405-4250
Phone
(253) 403-5432
NPI assigned
Jul 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD00021017 WA Primary

Addresses

Primary practice location

314 Martin Luther King Jr Way
Ste 104
Tacoma, WA 98405-4250

Mailing address

314 Martin Luther King Jr Way
Ste 104
Tacoma, WA 98405-4250
Phone (253) 403-5432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00021017WAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Aug 28, 2011 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Obstetrics & Gynecology CurrentSince Aug 28, 2011 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327881600000",
    "number": "1487654448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MARTIN LUTHER KING JR WAY",
            "address_2": "STE 104",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054250",
            "telephone_number": "253-403-5432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MARTIN LUTHER KING JR WAY",
            "address_2": "STE 104",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054250",
            "telephone_number": "253-403-5432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVANDA",
        "first_name": "CAROL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2012-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD00021017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.