Provider Demographics
NPI:1417981861
Name:NOVOA, JULIO C (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:C
Last Name:NOVOA
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:PO BOX 64551
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4551
Mailing Address - Country:US
Mailing Address - Phone:410-328-0253
Mailing Address - Fax:410-328-3379
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6640
Practice Address - Fax:410-328-2648
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD015019207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76558Medicare UPIN
MD52671100Medicare ID - Type Unspecified