Provider Demographics
NPI:1043771694
Name:NOVAK, MARY ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3500 N BROAD ST # 1A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4106
Mailing Address - Country:US
Mailing Address - Phone:215-707-2433
Mailing Address - Fax:
Practice Address - Street 1:8 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4351
Practice Address - Country:US
Practice Address - Phone:215-728-2941
Practice Address - Fax:215-214-1734
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV4292208800000X
PAOS024746208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology