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	2080P0207X	Pediatric Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011UJ	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902849961
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	:	301 HAWTHORNE LN
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2450
Country	:	US
Telephone Number	:	704-384-1900
Fax Number	:	704-384-1919

Authorized Official
Title or Position	:	VP FINANCE
Name	:	GEOFFREY K GARDNER
Credential	:
Telephone Number	:	704-384-1900

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/16/2013

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

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