Healthcare Provider Details

I. General information

NPI: 1497717334
Provider Name (Legal Business Name): PAMELA E. NOVAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LOCUST ST SUITE 200
AKRON OH
44302-1821
US

IV. Provider business mailing address

300 LOCUST ST SUITE 200
AKRON OH
44302-1821
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-7753
  • Fax: 330-253-4611
Mailing address:
  • Phone: 330-253-7753
  • Fax: 330-253-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35048164N
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: