Basic Information
| Provider Information | |||||||||
| NPI: | 1619947553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COVALESKY | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 N BROAD ST | ||||||||
| Address2: | 3RD FLR., ATTN: KIM EDWARDS | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674794165 | ||||||||
| FaxNumber: | 2154633820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 S BROAD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154635333 | ||||||||
| FaxNumber: | 2154638085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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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 | 207RC0000X | MD039820L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0011304760004 | 05 | PA | MEDICAID |