Provider Demographics
NPI:1366182024
Name:NOVEMBRE, NOAH (DO)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:NOVEMBRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 TIMBERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:STATE ROAD
Mailing Address - State:NC
Mailing Address - Zip Code:28676-8982
Mailing Address - Country:US
Mailing Address - Phone:336-831-3546
Mailing Address - Fax:
Practice Address - Street 1:809 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-692-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL87562207Q00000X, 207P00000X
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program