Provider Demographics
NPI:1427324300
Name:GOVERNATORI, NICHOLAS (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:GOVERNATORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HOWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5002
Mailing Address - Country:US
Mailing Address - Phone:814-889-2866
Mailing Address - Fax:814-889-6785
Practice Address - Street 1:620 HOWARD AVENUE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5002
Practice Address - Country:US
Practice Address - Phone:814-889-2866
Practice Address - Fax:814-889-6785
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454512207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine