Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Southport Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DINESH S PAI (VP OF OPERATIONS)
(704) 384-9104
Entity
Organization
Contact information
Practice address
1454 N HOWE ST, SUITE 202, SOUTHPORT, NC 28461-2754
(910) 457-9127
(910) 457-5211
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018M7
BCBS NC
NC
05
—
5904153
—
NC
Enumeration date
07/28/2006
Last updated
10/29/2009
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