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NPI Code Detail

MEDICARE: DENNIS RAYMOND NOVAK M.D.

MEDICARE: DENNIS RAYMOND NOVAK M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician010483ME

General Provider Information

NPI Number : 1679559611
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS RAYMOND NOVAK M.D.
Provider Business Mailing Address
First Line : PO BOX 1849
Second Line :
City : LEWISTON
State : ME
Zip : 04241-1849
Country : US
Telephone Number : 207-784-2554
Fax Number : 207-777-5363
Provider Business Practice Location Address
First Line : 300 MAIN ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7007
Country : US
Telephone Number : 207-795-2330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 07/08/2007

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