Provider Demographics
NPI:1336118991
Name:NOVOTNY, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:NOVOTNY
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 1:1600 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE G500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1700
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE G500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23499207X00000X, 207XS0106X
IN01045773A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100098070Medicaid
IN000000193876OtherANTHEM PROVIDER NUMBER
IN10825677OtherCAQH NUMBER
IN200119480Medicaid
OH2989057Medicaid
WV3810014348Medicaid
IN9397344OtherPHCS PID NUMBER
INE78397Medicare UPIN
IN10825677OtherCAQH NUMBER
IN815460LMedicare PIN
IN200031437Medicare PIN