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General NPI Number Information
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NPI Number | 1679528384
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Entity Type | Organization
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Legal Business Name | NOVANT MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 06/08/2008
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Provider Practice Location Address
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Address Line | 1029 N HOWE ST SUITE 100B
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City | SOUTHPORT
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State | NC
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Zip | 28461-3039
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Country | US
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Telephone | 910-457-9081
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Fax | 910-457-9083
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-384-7840
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Fax | 704-384-7830
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | DINESH S PAI
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Credential |
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Telephone | 704-384-9104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | NC
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