MEDICARE: NOVANT MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician		NC

General Provider Information

NPI Number	:	1134383870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-873-6065
Fax Number	:	704-873-6058

Provider Business Practice Location Address
First Line	:	1410 FERN CREEK DRIVE
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-4483
Country	:	US
Telephone Number	:	704-873-6065
Fax Number	:	704-873-6058

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	DINESH S PAI
Credential	:
Telephone Number	:	704-384-9113

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	09/11/2008

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