Provider Demographics
NPI:1053683870
Name:NOVOSAD, ELENA (PA - C)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:NOVOSAD
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:DANNENMAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 520
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3204
Mailing Address - Country:US
Mailing Address - Phone:832-562-3974
Mailing Address - Fax:832-663-3978
Practice Address - Street 1:920 MEDICAL PLAZA DR.,
Practice Address - Street 2:SUITE 520
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:832-562-3974
Practice Address - Fax:832-663-9378
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07691363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300040801Medicaid
TX300040801Medicaid