Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Mid Carolina Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP OF OPERATIONS)
(704) 384-9104
Entity
Organization
Contact information
Practice address
1718 E 4TH ST, STE 501, CHARLOTTE, NC 28204-3260
(704) 887-7563
(704) 887-7570
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019H6
BCBS-NC
NC
05
—
5908575
—
NC
01
—
DG5273
RAILROAD MEDICARE
NC
05
—
NPA577
—
SC
Enumeration date
07/29/2005
Last updated
07/19/2011
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