Provider Demographics
NPI:1821035460
Name:MCGOVERN, REGINA MAY (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MAY
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MAY
Other - Last Name:PLUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:832 GEORGIANA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3512
Mailing Address - Country:US
Mailing Address - Phone:360-457-0804
Mailing Address - Fax:360-457-7023
Practice Address - Street 1:832 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3512
Practice Address - Country:US
Practice Address - Phone:360-457-0804
Practice Address - Fax:360-457-7023
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038187207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8251258Medicaid
200041272OtherRAILROAD MEDICARE
WAG30879Medicare UPIN
WA8251258Medicaid
WA4719830001Medicare NSC