Provider Demographics
NPI:1003004276
Name:VINCENZO NOVARA MD PA
Entity Type:Organization
Organization Name:VINCENZO NOVARA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-295-6459
Mailing Address - Street 1:100 NW 170TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5513
Mailing Address - Country:US
Mailing Address - Phone:305-651-3033
Mailing Address - Fax:305-655-1153
Practice Address - Street 1:100 NW 170TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5513
Practice Address - Country:US
Practice Address - Phone:305-651-3033
Practice Address - Fax:305-655-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH173AMedicare PIN
FLAH173Medicare PIN