Healthcare Provider Details

I. General information

NPI: 1487652053
Provider Name (Legal Business Name): NOVASOM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CROMWELL PARK DRIVE, SUITE 108
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

801 CROMWELL PARK DRIVE, SUITE 108
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-0443
  • Fax: 410-590-4403
Mailing address:
  • Phone: 410-590-0443
  • Fax: 410-590-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY JOHN STOKES
Title or Position: PRESIDENT & COO
Credential:
Phone: 410-590-0443