Provider Demographics
NPI:1902466675
Name:NOVOTNY, JAMES KARL JR (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KARL
Last Name:NOVOTNY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:
Practice Address - Street 1:44 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2709
Practice Address - Country:US
Practice Address - Phone:440-735-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant