Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Carolina Family Practice & Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DINESH S. PAI (VP OPERATIONS)
(704) 384-7607
Entity
Organization
Contact information
Practice address
3700 NW CARY PKWY, SUITE 110, CARY, NC 27513-8446
(919) 238-2000
(919) 238-5010
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(919) 238-2000
(919) 238-5010
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020GY
BLUE CROSS
NC
01
—
1720251044
BLUE MEDICARE-PARTNERS
—
Enumeration date
04/08/2008
Last updated
06/23/2011
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