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Organization

NOVANT MEDICAL GROUP, INC.

Active
Other names
Southeast Children's Urology
Organization subpart
No

Provider details

NPI number
Authorized official
DINESH S PAI (VP OF OPERATIONS)
(704) 384-9104
Entity
Organization

Contact information

Practice address
16525 HOLLY CREST LN, SUITE 230, HUNTERSVILLE, NC 28078-4909
(704) 316-5140
(704) 316-5145
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830

Taxonomy

Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
018J1
BCBS
NC
05
5904654
NC
05
NPB185
SC
Enumeration date
08/16/2006
Last updated
08/18/2008
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