Provider Demographics
NPI:1518989581
Name:NOVARA, VINCENZO (MD)
Entity Type:Individual
Prefix:
First Name:VINCENZO
Middle Name:
Last Name:NOVARA
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 1:100 NW 170TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5513
Mailing Address - Country:US
Mailing Address - Phone:305-654-6890
Mailing Address - Fax:305-655-1153
Practice Address - Street 1:100 NW 170TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5513
Practice Address - Country:US
Practice Address - Phone:305-654-6890
Practice Address - Fax:305-655-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90971207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10536OtherBLUE CROSS BLUE SHIELD
FL276727900Medicaid
FL276727900OtherPSN
FL276727900OtherPSN
FL10536OtherBLUE CROSS BLUE SHIELD