Provider Demographics
NPI:1811070691
Name:NOVA PEDIATRICS AND ADOLESCENT MEDICINE, INC
Entity type:Organization
Organization Name:NOVA PEDIATRICS AND ADOLESCENT MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHITKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-399-7221
Mailing Address - Street 1:218 NORTHPARKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1179
Mailing Address - Country:US
Mailing Address - Phone:937-399-7221
Mailing Address - Fax:
Practice Address - Street 1:218 NORTHPARKE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1179
Practice Address - Country:US
Practice Address - Phone:937-399-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056393C208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0691096Medicaid