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General NPI Number Information
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NPI Number | 1124418058
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Entity Type | Organization
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Legal Business Name | MIKHAIL NOVIKOV MD PC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 318 MAIN STREET
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City | NORTHBOROUGH
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State | MA
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Zip | 01532
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Country | US
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Telephone | 508-936-1657
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Fax | 888-355-3778
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Provider Business Mailing Address
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Address Line | 10 THADDEUS MASON RD
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-2284
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Country | US
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Telephone | 617-209-7823
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Fax | 617-336-3306
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MIKHAIL NOVIKOV
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Credential | M.D.
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Telephone | 508-936-1657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 241998
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License Number State | MA
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