=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750308664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMIDIO MICHAEL NOVEMBRE DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 DUTCHMAN CT
-----------------------------------------------------
City | ELKIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28621-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-835-5330
-----------------------------------------------------
Fax | 336-835-5337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 N BRIDGE ST STE 101
-----------------------------------------------------
City | ELKIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28621-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-835-5330
-----------------------------------------------------
Fax | 336-835-5337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 2002-01393
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 200201393
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 200201393
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------