MEDICARE: MARCO A NOVA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME87202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023207800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCO A NOVA MD PA

Provider Business Mailing Address
First Line	:	6043 NW 167TH ST
Second Line	:	SUITE #A1
City	:	HIALEAH
State	:	FL
Zip	:	33015-4326
Country	:	US
Telephone Number	:	305-821-8282
Fax Number	:	305-824-3233

Provider Business Practice Location Address
First Line	:	6043 NW 167TH ST
Second Line	:	SUITE # A1
City	:	HIALEAH
State	:	FL
Zip	:	33015-4326
Country	:	US
Telephone Number	:	305-821-8282
Fax Number	:	305-824-3233

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCO A NOVA
Credential	:	MD
Telephone Number	:	305-821-8282

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/29/2007

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Directions to “MARCO A NOVA MD PA ” Practice Location

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