1902927155 NPI number — KARYN M GOVERNALE M.D.

Table of content: KARYN M GOVERNALE M.D. (NPI 1902927155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902927155 NPI number — KARYN M GOVERNALE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOVERNALE
Provider First Name:
KARYN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENTROP GOVERNALE
Provider Other First Name:
KARYN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902927155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 N HAMILTON RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-1757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-293-2614
Provider Business Mailing Address Fax Number:
614-293-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF FAMILY PRACTICE
Provider Business Practice Location Address City Name:
GAINESVILLE FL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-0237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-265-9478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007

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: 207Q00000X , with the licence number:  231366 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35.098518 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025184000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".