Provider Demographics
NPI:1487652053
Name:NOVASOM INC.
Entity Type:Organization
Organization Name:NOVASOM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-590-0443
Mailing Address - Street 1:801 CROMWELL PARK DRIVE,
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-590-0443
Mailing Address - Fax:410-590-4403
Practice Address - Street 1:801 CROMWELL PARK DRIVE,
Practice Address - Street 2:SUITE 108
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-590-0443
Practice Address - Fax:410-590-4403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVASOM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-08
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003144987AMedicaid
FL11051200Medicaid
TN1533877Medicaid
IN201192900Medicaid
MD421865500Medicaid
GA003144987AMedicaid
VAFVS004Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MDFMY001Medicare PIN
IN201192900Medicaid
TN1533877Medicaid