Healthcare Provider Details

I. General information

NPI: 1649836966
Provider Name (Legal Business Name): MICHAEL BOVA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 NOLL DR STE 2000
LANCASTER PA
17603-7614
US

IV. Provider business mailing address

620 N PINE ST
LANCASTER PA
17603-2824
US

V. Phone/Fax

Practice location:
  • Phone: 717-327-4694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS021314
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: