Provider Demographics
NPI:1437457124
Name:NOVAK, MELISSA EAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:EAGAN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:485 TITUS AVENUE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617
Mailing Address - Country:US
Mailing Address - Phone:585-266-0310
Mailing Address - Fax:585-266-9207
Practice Address - Street 1:485 TITUS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3535
Practice Address - Country:US
Practice Address - Phone:585-266-0310
Practice Address - Fax:585-266-9207
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223748-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics