1841444361 NPI number — NOVANT MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841444361 NPI number — NOVANT MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVANT MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MID CAROLINA CARDIOLOGY - BALLANTYNE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841444361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1718 E 4TH ST
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28204-3261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-887-7563
Provider Business Mailing Address Fax Number:
704-887-7570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15825 JOHN J DELANEY DR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-264-3500
Provider Business Practice Location Address Fax Number:
704-264-1393
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAI
Authorized Official First Name:
DINESH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
704-384-9104

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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