Provider Demographics
NPI:1497717334
Name:NOVAK, PAMELA E (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LOCUST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1821
Mailing Address - Country:US
Mailing Address - Phone:330-253-7753
Mailing Address - Fax:330-253-4611
Practice Address - Street 1:300 LOCUST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1821
Practice Address - Country:US
Practice Address - Phone:330-253-7753
Practice Address - Fax:330-253-4611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048164N208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0574703Medicaid