DR. THOMAS WILLIAM MCGOVERN (NPI# 1982702742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982702742 |
| Entity Type | Individual |
| Full Name | DR. THOMAS WILLIAM MCGOVERN |
| Credential | M.D. |
| Practice Address |
5750 Falls Dr Fort Wayne IN 46804-7147 |
| Practice Telephone | 2604368000 |
| Practice Fax Number | 2604325587 |
| Mailing Telephone | 2604368000 |
| Mailing Fax Number | 2604325587 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-11-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 01052178A | IN | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
01052178A | IN | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
01052178A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PHP | 2576 | 01 | |
| BCBS | 000000308075 | 01 | |
| IN | CSR LICENSE NUMBER | 01052178B | 01 |
| IN | 200254690 | 05 | |
| AETNA | 5878557 | 01 | |
| IN | DEA LICENSE NUMBER | BM5768556 | 01 |
| MEDICARE RAILROAD | P00060564 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588675185 | Thomas A Mcgovern | Chiropractor | 4965 Kings Hwy N, Emmaus, PA 18049-5128 | 2006-08-10 |
| 1174529168 | Thomas Patrick Mcgovern | Specialist | 927 5th Ave, New York, NY 10021-2650 | 2005-06-23 |
| 1780606905 | Thomas Michael Mcgovern | Surgery | 1020 E Lake St, Suite B, Tyler, TX 75701-2030 | 2006-07-24 |
| 1083661912 | Thomas F Mcgovern | Orthopaedic Surgery | 7 Alumni Dr, Exeter, NH 03833-2118 | 2006-05-27 |
| 1720064090 | Thomas Mcgovern | Counselor | 3601 4th St, Suite 1c102, Lubbock, TX 79430-0002 | 2005-12-19 |
| Street Address |
5750 FALLS DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-7147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235237074 | Diane Marie Hentz | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| 1457766594 | Benjamin A Giarmo | Nurse Practitioner | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2014-06-27 |
| 1730212838 | Diane Bernardi | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2007-03-14 |
| 1407956923 | James Richard Kyler | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-24 |
| 1871693382 | William Charles Lentz | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-24 |
| 1548368301 | Edward Charles Sarkisian | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| 1134227911 | Jennifer Lynn Hobbs | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| 1194823989 | Pamela Sue Shoda | Nurse Practitioner | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| 1790883502 | Nicole Marie Helsom | Physician Assistant | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235237074 | Diane Marie Hentz | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2006-09-20 |
| 1497787659 | Keith Bryan Danckaert | Dermatology | 10620 Corporate Dr, Suite A, Fort Wayne, IN 46845-1711 | 2006-07-07 |
| 1396248415 | Jacquelyn Ray Beemer | Dermatology | 5650 Coventry Ln, Fort Wayne, IN 46804-7140 | 2018-03-15 |
| 1245686989 | Fort Wayne Integrative Medicine | Dermatology | 3919 W Jefferson Blvd, Fort Wayne, IN 46804-6811 | 2016-05-12 |
| 1881055069 | Forefront Dermatology, S.c. | Dermatology | 10620 Corporate Dr, Suite A, Fort Wayne, IN 46845 | 2016-03-15 |
| 1902291875 | Robert Stephen Bednarek | Dermatology | 11050 Parkview Circle Dr, Fort Wayne, IN 46845-1739 | 2015-03-30 |
| 1043499221 | Dermatology and Laser Surgery Associates of Fort Wayne P.C. | Dermatology | 10620 Corporate Dr, Suite A, Fort Wayne, IN 46845-1711 | 2007-10-24 |
| 1265648299 | Diana Castanon Westgate | Dermatology | 11123 Parkview Plaza Dr Ste 201, Fort Wayne, IN 46845-1707 | 2007-05-15 |
| 1598883035 | Tina Renee Kinsley | Dermatology | 10620 Corporate Dr, Fort Wayne, IN 46845 | 2007-03-26 |
| 1730212838 | Diane Bernardi | Dermatology | 5750 Falls Dr, Fort Wayne, IN 46804-7147 | 2007-03-14 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.