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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235393802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1718 E 4TH ST
Second Line	:	SUITE 902
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3261
Country	:	US
Telephone Number	:	919-554-9412
Fax Number	:	919-562-7013

Provider Business Practice Location Address
First Line	:	102 SOUTHTOWN CIR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9591
Country	:	US
Telephone Number	:	919-554-9412
Fax Number	:	919-562-7013

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	DINESH PAI
Credential	:
Telephone Number	:	704-384-9104

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/31/2008

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