1497874630 NPI number — DR. ANGELA M MCGOVERN MD

Table of content: DR. ANGELA M MCGOVERN MD (NPI 1497874630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497874630 NPI number — DR. ANGELA M MCGOVERN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGOVERN
Provider First Name:
ANGELA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497874630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191
Provider Second Line Business Mailing Address:
PROVIDER ENROLLMENT DEPT
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19732-0191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-651-6212
Provider Business Mailing Address Fax Number:
302-651-4945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BRYN MAWR HOSPITAL
Provider Second Line Business Practice Location Address:
130 S. BRYN MAWR AVE.
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-526-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD424485 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: MD424485 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101849316 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212052 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127621 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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