Provider Demographics
NPI:1922031293
Name:NOWAK, RENATA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATA
Middle Name:A
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RENATA
Other - Middle Name:A
Other - Last Name:DRABIK-NOWAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10580 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7301
Mailing Address - Country:US
Mailing Address - Phone:571-432-2600
Mailing Address - Fax:571-432-2787
Practice Address - Street 1:10580 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7301
Practice Address - Country:US
Practice Address - Phone:571-432-2600
Practice Address - Fax:571-432-2787
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255686207R00000X
TN30440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730302Medicaid
TNG82306Medicare UPIN
TN3830285Medicare PIN