Provider Demographics
NPI:1255691788
Name:MARY JANE BOVO, MD, PC
Entity Type:Organization
Organization Name:MARY JANE BOVO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-294-8565
Mailing Address - Street 1:2602 WILMINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1537
Mailing Address - Country:US
Mailing Address - Phone:201-294-8565
Mailing Address - Fax:212-208-4409
Practice Address - Street 1:2602 WILMINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1537
Practice Address - Country:US
Practice Address - Phone:201-294-8565
Practice Address - Fax:212-208-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-030066E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty