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	207R00000X	Internal Medicine Physician		NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC5118	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0271T	OTHER	NC	BCBS-NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487692273
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	:	704-384-7283
Fax Number	:	704-316-0508

Provider Business Practice Location Address
First Line	:	1701 ABBEY PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3733
Country	:	US
Telephone Number	:	704-384-1800
Fax Number	:	704-384-1830

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DINESH S. PAI
Credential	:
Telephone Number	:	704-384-9113

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/15/2008

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