Provider Demographics
NPI:1447281399
Name:MCGOVERN, PAUL CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:3910 BUILDING, 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9990
Mailing Address - Fax:215-243-4658
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:3910 BUILDING, 2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-9990
Practice Address - Fax:215-243-4658
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066905L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018751260001Medicaid
PA054935Medicare ID - Type Unspecified
PA0018751260001Medicaid
H55091Medicare UPIN