Healthcare Provider Details

I. General information

NPI: 1275514473
Provider Name (Legal Business Name): YOGESH K GOVIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD KLEIN BLDG, SUITE 202
PHILADELPHIA PA
19141-3030
US

IV. Provider business mailing address

101 E OLNEY AVE SUITE 505
PHILADELPHIA PA
19120-2421
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8210
  • Fax: 215-329-1085
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD063810L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: