Provider Demographics
NPI:1629041983
Name:MCGOVERN, CHARLES EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDGAR
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 STATE ROAD 229
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-6808
Mailing Address - Country:US
Mailing Address - Phone:812-934-6400
Mailing Address - Fax:812-934-6330
Practice Address - Street 1:1033 STATE ROAD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-6808
Practice Address - Country:US
Practice Address - Phone:812-934-6400
Practice Address - Fax:812-934-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035283A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100211890AMedicaid
INE08096Medicare UPIN
IN701260Medicare PIN