Healthcare Provider Details

I. General information

NPI: 1720251044
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 NW CARY PKWY SUITE 110
CARY NC
27513-8446
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 919-238-2000
  • Fax: 919-238-5010
Mailing address:
  • Phone: 919-238-2000
  • Fax: 919-238-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DINESH S. PAI
Title or Position: VP OPERATIONS
Credential:
Phone: 704-384-7607