Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
South Park Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DINESH S. PAI (VP OF OPERATIONS)
(704) 384-9104
Entity
Organization
Contact information
Practice address
4601 PARK RD, SUITE 100, CHARLOTTE, NC 28209-3239
(704) 522-6656
(704) 522-6665
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9679
(704) 316-0508
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018PY
BCBS NC
NC
05
—
5905826
—
NC
Enumeration date
09/01/2006
Last updated
07/17/2008
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