Provider Demographics
NPI:1538587696
Name:MCGOVERN, KERRI ANNE (MD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:MCGOVERN
Suffix:
Gender:F
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:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:3151 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2370
Practice Address - Country:US
Practice Address - Phone:513-584-7848
Practice Address - Fax:513-584-4281
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.148646207RX0202X
NC2020-02630207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology