Provider Demographics
NPI:1689799439
Name:BOVE, MARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:BOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARY ELIZABETH
Other - Middle Name:BOVE
Other - Last Name:DONEGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 SPROUL ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008
Mailing Address - Country:US
Mailing Address - Phone:610-284-0200
Mailing Address - Fax:610-353-7932
Practice Address - Street 1:2000 SPROUL ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-284-0200
Practice Address - Fax:610-353-7932
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC70003540208000000X
PAPA MT188590208000000X
PAMD436273208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist