Provider Demographics
NPI:1265800023
Name:COVACHA, ANDRE (PA-C)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:COVACHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3843
Mailing Address - Country:US
Mailing Address - Phone:401-642-2072
Mailing Address - Fax:401-305-3958
Practice Address - Street 1:2140 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-642-2072
Practice Address - Fax:401-305-3958
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICPA00837363A00000X
MAPA7807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant