Provider Demographics
NPI:1750308664
Name:NOVEMBRE, EMIDIO MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:EMIDIO
Middle Name:MICHAEL
Last Name:NOVEMBRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DUTCHMAN CT
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2237
Mailing Address - Country:US
Mailing Address - Phone:336-835-5330
Mailing Address - Fax:336-835-5337
Practice Address - Street 1:110 DUTCHMAN CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2237
Practice Address - Country:US
Practice Address - Phone:336-835-5330
Practice Address - Fax:336-835-5337
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201393207LP2900X, 207QA0401X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010126401Medicaid
NC89132UVMedicaid
NC89132UVMedicaid
NCF82262Medicare UPIN