Healthcare Provider Details

I. General information

NPI: 1649314246
Provider Name (Legal Business Name): NONA PEREZ NOVELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

1000 RIVER RD STE 100
CONSHOHOCKEN PA
19428-2439
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-7000
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0054702
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD31370
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: