=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043261647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVANT MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 08/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11304 HAWTHORNE DR SUITE 100
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-384-8760
-----------------------------------------------------
Fax | 704-384-8783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60447
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-0447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-384-7607
-----------------------------------------------------
Fax | 704-316-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | DINESH S. PAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-384-9113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------