Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Pediatric Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 700, CHARLOTTE, NC 28207-1167
(704) 316-1220
(704) 316-1230
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-1220
(704) 316-1230
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016XK
BCBS
NC
05
—
5900388
—
NC
05
—
NPB105
—
SC
Enumeration date
05/26/2006
Last updated
06/14/2024
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