Organization
NOVANT MEDICAL GROUP, INC.
Active
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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