Healthcare Provider Details

I. General information

NPI: 1790743474
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 MILLS PARK DR
ROCK HILL SC
29732-8599
US

IV. Provider business mailing address

2670 MILLS PARK DR
ROCK HILL SC
29732-8599
US

V. Phone/Fax

Practice location:
  • Phone: 803-985-3939
  • Fax: 803-985-3929
Mailing address:
  • Phone: 803-985-3939
  • Fax: 803-985-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal 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