Provider Demographics
NPI:1639155203
Name:NOVENA, A. MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:MICHAEL
Last Name:NOVENA
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 1:55 CAREN AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2515
Mailing Address - Country:US
Mailing Address - Phone:614-846-1527
Mailing Address - Fax:614-846-1704
Practice Address - Street 1:55 CAREN AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2515
Practice Address - Country:US
Practice Address - Phone:614-846-1527
Practice Address - Fax:614-846-1704
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664357Medicaid
OH0598954Medicare PIN
OH0664357Medicaid