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NPI Code Detail

MEDICARE: NOVANT MEDICAL GROUP, INC.

MEDICARE: NOVANT MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology Physician32077NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2019C0OTHERNCBCBS OF NC

General Provider Information

NPI Number : 1174731988
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVANT MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-384-9679
Fax Number : 704-316-0508
Provider Business Practice Location Address
First Line : 5933 BLAKENEY PARK DR
Second Line : STE 101
City : CHARLOTTE
State : NC
Zip : 28277-5713
Country : US
Telephone Number : 704-316-2061
Fax Number : 704-316-2062
Authorized Official
Title or Position : VP OF OPERATIONS
Name : DINESH S. PAI
Credential :
Telephone Number : 704-384-9104
Provider Enumeration Date : 05/18/2007
Last Update Date : 06/09/2008

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