Provider Demographics
NPI:1720075021
Name:NOVAK, SUSAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:P
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 MADISON OAK DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4084
Mailing Address - Country:US
Mailing Address - Phone:210-946-1300
Mailing Address - Fax:210-402-1568
Practice Address - Street 1:502 MADISON OAK DR
Practice Address - Street 2:SUITE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4084
Practice Address - Country:US
Practice Address - Phone:210-946-1300
Practice Address - Fax:210-402-1568
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1803OtherLICENSE
TX207543401Medicaid