Provider Demographics
NPI:1699077438
Name:MELVYN H. NOVEGROD, M.D., INC.
Entity type:Organization
Organization Name:MELVYN H. NOVEGROD, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-546-1121
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:401
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-546-1121
Mailing Address - Fax:714-546-0428
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:401
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-546-1121
Practice Address - Fax:714-546-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64428YOtherBLUE SHIELD OF CALIFORNIA