Provider Demographics
NPI:1376515510
Name:NOVA, MARCO A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:NOVA
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 1:6043 NW 167TH STREET
Mailing Address - Street 2:SUITE # A 1
Mailing Address - City:MIAMI
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 STREET
Practice Address - Street 2:SUITE # A1
Practice Address - City:MIAMI
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH69385Medicare UPIN
FLU2568ZMedicare ID - Type Unspecified