Basic Information
| Provider Information | |||||||||
| NPI: | 1104261874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COVINGTON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | PHILIP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16259 SYLVESTER RD SW STE 404 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062433049 | ||||||||
| FaxNumber: | 2069654199 | ||||||||
| Practice Location | |||||||||
| Address1: | 16259 SYLVESTER RD SW STE 404 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062433049 | ||||||||
| FaxNumber: | 2069654199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD60788009 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 5499181-1205 | UT | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207R00000X | R73802 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2088786 | 05 | WA | MEDICAID |