NOVANT MEDICAL GROUP, INC

Provider Demographics

• NPI: 1346398435
• Name: NOVANT MEDICAL GROUP, INC
• Entity Type: Organization
• Organization Name: NOVANT MEDICAL GROUP, INC
• Authorized Official - Title/Position: VP OF FINANCE
• Authorized Official - First Name: GEOFFREY
• Authorized Official - Last Name: GARDNER
• Authorized Official - Phone: 704-384-9094
• Mailing Address - Street 1: PO BOX 60447
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28260-0447
• Mailing Address - Country: US
• Mailing Address - Phone: 704-384-7840
• Mailing Address - Fax: 704-384-7830
• Practice Address - Street 1: 108 PROVIDENCE RD
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28207-1218
• Practice Address - Country: US
• Practice Address - Phone: 704-384-9679
• Practice Address - Fax: 704-316-0508
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-01-08
• Last Update Date: 2011-10-06

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207N00000X	Allopathic & Osteopathic Physicians	Dermatology		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RE0101X	Allopathic & Osteopathic Physicians	Internal Medicine	Endocrinology, Diabetes & Metabolism	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	207VX0201X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecologic Oncology	Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2080N0001X	Allopathic & Osteopathic Physicians	Pediatrics	Neonatal-Perinatal Medicine	Group - Multi-Specialty
No	2080P0202X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Cardiology	Group - Multi-Specialty
No	2080P0207X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Hematology-Oncology	Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	2344688G	Medicare PIN
NC	2319872E	Medicare PIN
NC	2319872H	Medicare PIN
NC	2322229C	Medicare PIN
NC	2343183B	Medicare PIN
NC	2344688	Medicare PIN
NC	2344688D	Medicare PIN
NC	2319872D	Medicare PIN
NC	2319872	Medicare PIN
NC	2319872T	Medicare PIN
NC	2322229A	Medicare PIN
NC	2325721	Medicare PIN
NC	2343183G	Medicare PIN
NC	2343183T	Medicare PIN
NC	2322229E	Medicare PIN
NC	2319872M	Medicare PIN
NC	2343183E	Medicare PIN
NC	2319872S	Medicare PIN
NC	2319872K	Medicare PIN
NC	2344668B	Medicare PIN