Provider Demographics
NPI:1376534404
Name:MCGOVERN, JESSICA ERIN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS. GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:111 WILLARD ST
Practice Address - Street 2:MILTON PEDIATRIC ASSOCIATES
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1200
Practice Address - Country:US
Practice Address - Phone:617-472-6100
Practice Address - Fax:617-770-3758
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA221793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28075OtherBCBS OF MA
MA469821OtherTUFTS HEALTH PLAN