Provider Demographics
NPI:1992964696
Name:GO, MYLENE SY (MD)
Entity type:Individual
Prefix:DR
First Name:MYLENE
Middle Name:SY
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 341
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-619-7420
Mailing Address - Fax:610-876-6923
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 341
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-619-7420
Practice Address - Fax:610-876-6923
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2014-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09055400207RH0003X
PAMD435113207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0306720Medicaid
NJ0306720Medicaid
PA127393G48Medicare PIN
DE173126ZFYNMedicare PIN