Provider Demographics
NPI:1124185590
Name:MCGOVERN, CHRISTINE ELIZABETH (RPA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WASHINGTON AVE
Mailing Address - Street 2:UNIVERSITY HEALTH CENTER
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12222-0100
Mailing Address - Country:US
Mailing Address - Phone:518-442-5454
Mailing Address - Fax:
Practice Address - Street 1:1400 WASHINGTON AVE
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12222-0100
Practice Address - Country:US
Practice Address - Phone:518-442-5454
Practice Address - Fax:518-442-5444
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0004254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical