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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902054810
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	:	704-855-2400
Fax Number	:	704-857-1836

Provider Business Practice Location Address
First Line	:	308 E CENTERVIEW ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-855-2400
Fax Number	:	704-857-1836

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	DINESH S. PAI
Credential	:
Telephone Number	:	704-384-9104

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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