Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Azalea Coast Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DINESH PAI (VP OF OPERATIONS)
(704) 384-9104
Entity
Organization
Contact information
Practice address
7110 WRIGHTSVILLE AVE, SUITE B4, WILMINGTON, NC 28403-7219
(910) 256-2877
(910) 256-2928
Mailing address
7110 WRIGHTSVILLE AVE, SUITE B4, WILMINGTON, NC 28403-7219
(910) 256-2877
(910) 256-2928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019F6
BCBS NC
NC
05
—
5906521
—
NC
Enumeration date
01/11/2006
Last updated
06/08/2008
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