Basic Information
| Provider Information | |||||||||
| NPI: | 1689799439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOVE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DONEGAN | ||||||||
| OtherFirstName: | MARY ELIZABETH | ||||||||
| OtherMiddleName: | BOVE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2000 SPROUL ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102840200 | ||||||||
| FaxNumber: | 6103537932 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 SPROUL ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102840200 | ||||||||
| FaxNumber: | 6103537932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 04/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C70003540 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | PA MT188590 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD436273 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | MD436273 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD436273 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.