Healthcare Provider Details

I. General information

NPI: 1295894582
Provider Name (Legal Business Name): DAVID A. NOVOTNY M D, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36855 AMERICAN WAY SUITE 2D
AVON OH
44011-4045
US

IV. Provider business mailing address

36855 AMERICAN WAY SUITE 2D
AVON OH
44011-4045
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-2770
  • Fax: 440-934-2774
Mailing address:
  • Phone: 440-934-2770
  • Fax: 440-934-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A NOVOTNY
Title or Position: OWNER
Credential: MD
Phone: 440-934-2770