Provider Demographics
NPI:1710020656
Name:ALTHAUSEN MCGOVERN ASSOC INC
Entity type:Organization
Organization Name:ALTHAUSEN MCGOVERN ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-523-2394
Mailing Address - Street 1:1 HAWTHORNE PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2333
Mailing Address - Country:US
Mailing Address - Phone:617-557-5422
Mailing Address - Fax:617-523-8974
Practice Address - Street 1:1 HAWTHORNE PL
Practice Address - Street 2:SUITE 109
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2333
Practice Address - Country:US
Practice Address - Phone:617-557-5422
Practice Address - Fax:617-523-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55277208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA340015721OtherRR MEDICARE
MAM16636OtherMEDEX
MA9738037Medicaid
MA0004946OtherNHP
MAM16636OtherBLUE CROSS
MA616567OtherTUFTS
MAM16636OtherBLUE CROSS
MA=========OtherHARVARD PILGRIM
MA616567OtherTUFTS