Provider Demographics
NPI:1609577303
Name:KOVACK, VICTOR ALAN
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALAN
Last Name:KOVACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 SPEEDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3349
Mailing Address - Country:US
Mailing Address - Phone:304-594-9619
Mailing Address - Fax:
Practice Address - Street 1:1857 SPEEDWAY AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3349
Practice Address - Country:US
Practice Address - Phone:304-594-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant