Provider Demographics
NPI:1952344327
Name:NOVAK, MAUREEN A (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANNE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-334-1340
Practice Address - Fax:352-334-1348
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62866Medicare UPIN
FL25757Medicare ID - Type Unspecified
FL25757ZMedicare PIN