Provider Demographics
NPI:1902927155
Name:GOVERNALE, KARYN M (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:M
Last Name:GOVERNALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:M
Other - Last Name:ENTROP GOVERNALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:920 N HAMILTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1757
Mailing Address - Country:US
Mailing Address - Phone:614-293-2614
Mailing Address - Fax:614-293-7001
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:DEPARTMENT OF FAMILY PRACTICE
Practice Address - City:GAINESVILLE FL
Practice Address - State:FL
Practice Address - Zip Code:32610-0237
Practice Address - Country:US
Practice Address - Phone:352-265-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231366207Q00000X
OH35.098518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025184000Medicaid