Individual
DR. THOMAS WILLIAM MCGOVERN
Active
Individual
DR. THOMAS WILLIAM MCGOVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01052178A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
01052178A
IN
207NS0135X
Procedural Dermatology Physician
01052178A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000308075
BCBS
—
01
—
01052178B
CSR LICENSE NUMBER
IN
05
—
200254690
—
IN
01
—
2576
PHP
—
01
—
5878557
AETNA
—
01
—
P00060564
MEDICARE RAILROAD
—
Enumeration date
09/20/2006
Last updated
03/07/2023
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