Provider Demographics
NPI:1447434956
Name:NOVANT MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:NOVANT MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9113
Mailing Address - Street 1:509 OLDE WATERFORD WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4125
Mailing Address - Country:US
Mailing Address - Phone:910-283-1500
Mailing Address - Fax:910-283-1504
Practice Address - Street 1:509 OLDE WATERFORD WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4125
Practice Address - Country:US
Practice Address - Phone:910-283-1500
Practice Address - Fax:910-283-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908896Medicaid
NC2322229VMedicare PIN