Provider Demographics
NPI:1770761207
Name:MAGOVERN, ASHLEY FOWLER (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:FOWLER
Last Name:MAGOVERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6814
Mailing Address - Country:US
Mailing Address - Phone:310-546-1188
Mailing Address - Fax:
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-546-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103514207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology