Provider Demographics
NPI:1629067319
Name:NOVAK, GORDON M (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:M
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:690 CANTON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2321
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2777
Practice Address - Fax:617-254-6384
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-11-25
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Provider Licenses
StateLicense IDTaxonomies
MA154452207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3180981Medicaid
G70740Medicare UPIN
MA3180981Medicaid