Provider Demographics
NPI:1437771904
Name:NOVAK, LUCIA (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AURA
Other - Middle Name:LUCIA
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:324 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 LAKE CONCORD RD NE # A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2926
Practice Address - Country:US
Practice Address - Phone:704-782-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-11788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program