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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
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2017AFOTHERNCBCBS-NC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245253103
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 : 704-384-7840
Fax Number : 704-384-7830
Provider Business Practice Location Address
First Line : 1404 E FRANKLIN ST
Second Line :
City : MONROE
State : NC
Zip : 28112-5160
Country : US
Telephone Number : 704-384-8460
Fax Number : 704-316-2005
Authorized Official
Title or Position : VP OF OPERATIONS
Name : DINESH S PAI
Credential :
Telephone Number : 704-384-9104
Provider Enumeration Date : 07/25/2006
Last Update Date : 08/15/2008

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Directions to “NOVANT MEDICAL GROUP, INC. ” Practice Location

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