MEDICARE: ROBERTO NOVOA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35057654	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083619258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO NOVOA MD

Provider Business Mailing Address
First Line	:	PO BOX 6329
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44706-0329
Country	:	US
Telephone Number	:	330-363-1341
Fax Number	:	330-363-0074

Provider Business Practice Location Address
First Line	:	2600 SIXTH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	330-363-1341
Fax Number	:	330-363-0074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/16/2010

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Directions to “ ROBERTO NOVOA MD” Practice Location

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