Healthcare Provider Details

I. General information

NPI: 1174731988
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 BLAKENEY PARK DR STE 101
CHARLOTTE NC
28277-5713
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-2061
  • Fax: 704-316-2062
Mailing address:
  • Phone: 704-384-9679
  • Fax: 704-316-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number32077
License Number StateNC

VIII. Authorized Official

Name: DINESH S. PAI
Title or Position: VP OF OPERATIONS
Credential:
Phone: 704-384-9104