Provider Demographics
NPI:1720037377
Name:MCGOWAN, JANE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N BROAD ST
Mailing Address - Street 2:HAHNEMANN UNIVERSITY HOSPITAL, MS 492
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1121
Mailing Address - Country:US
Mailing Address - Phone:215-762-6647
Mailing Address - Fax:215-762-7139
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:HAHNEMANN UNIVERSITY HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-6647
Practice Address - Fax:215-762-7139
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKR48JHMedicare ID - Type UnspecifiedGROUP
MDA734Medicare ID - Type UnspecifiedINDIVIDUAL
MDE89130Medicare UPIN