Provider Demographics
NPI:1427072479
Name:NOVOTNY, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:30 LOCUST STREET
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0911
Mailing Address - Country:US
Mailing Address - Phone:413-582-2898
Mailing Address - Fax:413-582-2958
Practice Address - Street 1:30 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01061
Practice Address - Country:US
Practice Address - Phone:413-582-2792
Practice Address - Fax:413-582-4675
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0006447207R00000X
MA46176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44189OtherHEALTH NEW ENGLAND
MAAA191022OtherHARVARD PILGRIM HEALTH PLAN
MA110087091AMedicaid
VT0005274Medicaid
MA1427072479OtherFALLON COMMUNITY HEALTH PLAN
MA110738OtherBMC HEALTH NET
MA1427072479OtherBLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS
MA4540683OtherAETNA
MA6004659OtherCIGNA
MA754694OtherTUFTS
MA046176OtherCONNECTICARE
VT0005274Medicaid
MA110738OtherBMC HEALTH NET