Healthcare Provider Details

I. General information

NPI: 1750308664
Provider Name (Legal Business Name): EMIDIO MICHAEL NOVEMBRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUTCHMAN CT
ELKIN NC
28621-2237
US

IV. Provider business mailing address

1925 N BRIDGE ST STE 101
ELKIN NC
28621-2105
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-5330
  • Fax: 336-835-5337
Mailing address:
  • Phone: 336-835-5330
  • Fax: 336-835-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number2002-01393
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200201393
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number200201393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: