Provider Demographics
NPI:1093737975
Name:NOVA MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:NOVA MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-586-0994
Mailing Address - Street 1:2991 CROUSE LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8833
Mailing Address - Country:US
Mailing Address - Phone:336-586-0994
Mailing Address - Fax:336-586-9363
Practice Address - Street 1:2991 CROUSE LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-586-0994
Practice Address - Fax:336-586-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790190AMedicaid
NCA678OtherPARTNERS HEALTH PLAN
NC0190AOtherBCBS OF NC GROUP NUMBER
NC790190AMedicaid