Basic Information
| Provider Information | |||||||||
| NPI: | 1184785859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVACS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 WALTER REED RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153350 | ||||||||
| FaxNumber: | 9103216253 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 WALTER REED RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153350 | ||||||||
| FaxNumber: | 9103216253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 02/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 234548 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 2010-01733 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02644604 | 05 | NY | MEDICAID | 110404000053 | 01 | FIDELIS | OTHER | 1184785859 | 01 | NOVA | OTHER | 1184785859 | 01 | EMPIRE | OTHER | 1184785859 | 01 | AETNA | OTHER | 0512831 | 01 | NY | INDEPENDENT HEALTH | OTHER | 1184785859 | 01 | NORTH AMERICAN | OTHER | 1184785859 | 01 | BLUE CROSS | OTHER | 1184785859 | 01 | NY | UNIVERA | OTHER | 1184785859 | 01 | TRICARE | OTHER | 1184785859 | 01 | NY | HUMANA | OTHER | 1184785859 | 01 | GHI | OTHER |