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	2083X0100X	Occupational Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1609030196
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	:	843-383-5191
Fax Number	:	843-383-8895

Provider Business Practice Location Address
First Line	:	206 SWIFT CREEK RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4383
Country	:	US
Telephone Number	:	843-383-5191
Fax Number	:	843-383-8895

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	03/19/2009

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