Provider Demographics
NPI:1770674004
Name:MCGOVERN, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-3330
Mailing Address - Street 2:REPRODUCTIVE ENDOCRINOLOGY OF SLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-3330
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-333-1075
Practice Address - Street 1:249 EAST 58TH STREET
Practice Address - Street 2:REPRODUCTIVE ENDOCRINOLOGY OF SLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-523-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA54273207VE0102X
NY171501-1207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162520RNQMedicare ID - Type Unspecified
NJF41708Medicare UPIN