Individual
PHILIP COVERDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18697 BAGLEY RD, MIDDLEBURG HEIGHTS, OH 44130-3417
(440) 816-8000
Mailing address
24049 SHAKER BLVD, SHAKER HEIGHTS, OH 44122-2684
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35048557C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0518014
—
OH
01
—
942460636351
CARESOURCE
OH
01
—
P00194271
MEDICARE RR-GA
OH
Enumeration date
06/19/2006
Last updated
07/08/2007
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