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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
1207V00000XObstetrics & Gynecology PhysicianNC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1011V2OTHERNCBCBS NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326176561
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVANT MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 602362
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2362
Country : US
Telephone Number : 704-321-1077
Fax Number : 704-321-1086
Provider Business Practice Location Address
First Line : 1450 MATTHEWS TOWNSHIP PKWY
Second Line : STE 300
City : MATTHEWS
State : NC
Zip : 28105-5332
Country : US
Telephone Number : 704-321-1077
Fax Number : 704-321-1086
Authorized Official
Title or Position : VP OF FINANCE
Name : GEOFFREY K GARDNER
Credential :
Telephone Number : 704-321-1077
Provider Enumeration Date : 03/01/2007
Last Update Date : 06/26/2013

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