Healthcare Provider Details

I. General information

NPI: 1649342072
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET BLVD N SUITE B
SUNSET BEACH NC
28468-4345
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-0006
  • Fax: 910-575-3972
Mailing address:
  • Phone: 704-384-9679
  • Fax: 704-316-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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