Provider Demographics
NPI:1164413639
Name:NOVELLO, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:NOVELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-2503
Mailing Address - Fax:603-740-2497
Practice Address - Street 1:789 CENTRAL AVENUE
Practice Address - Street 2:LEVEL 2
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2503
Practice Address - Fax:603-740-2497
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8718208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1164413639Medicaid
NH3074907Medicaid
NHP00751353OtherRR MEDICARE
NHP00751353OtherRR MEDICARE
NHB37018Medicare UPIN