Basic Information
| Provider Information | |||||||||
| NPI: | 1609969625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COVALESKY | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 N BROAD ST | ||||||||
| Address2: | 3RD FLR CARDIOLOGY CONSULTANTS OF PHILA | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154627100 | ||||||||
| FaxNumber: | 2154633820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 S BROAD ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191481536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154635353 | ||||||||
| FaxNumber: | 2154638085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA002765L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MA002765L | 01 | PA | LICENSE # | OTHER |