Provider Demographics
NPI:1023207800
Name:MARCO A NOVA MD PA
Entity Type:Organization
Organization Name:MARCO A NOVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-821-8282
Mailing Address - Street 1:6043 NW 167TH ST
Mailing Address - Street 2:SUITE #A1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4326
Mailing Address - Country:US
Mailing Address - Phone:305-821-8282
Mailing Address - Fax:305-824-3233
Practice Address - Street 1:6043 NW 167TH ST
Practice Address - Street 2:SUITE # A1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4326
Practice Address - Country:US
Practice Address - Phone:305-821-8282
Practice Address - Fax:305-824-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty