Provider Demographics
NPI:1215975354
Name:INAM, NOVERA INAM (MD)
Entity type:Individual
Prefix:
First Name:NOVERA
Middle Name:INAM
Last Name:INAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PARKS HALL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1359
Mailing Address - Country:US
Mailing Address - Phone:740-593-4609
Mailing Address - Fax:740-593-4166
Practice Address - Street 1:795 SIM HODGIN PKWY
Practice Address - Street 2:REID HEALTH RESIDENCY CLINIC
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1928
Practice Address - Country:US
Practice Address - Phone:765-966-5949
Practice Address - Fax:765-962-6268
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123422207Q00000X
IN01061456A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001099709OtherANTHEM
IN200821660Medicaid
IN259730174OtherMEDICARE