Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Heart and Vascular Institute
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
125 QUEENS RD STE 250, CHARLOTTE, NC 28204-3215
(704) 316-5100
(704) 316-5101
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5100
(704) 316-5101
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015GA
BCBS NC
NC
05
—
89015GA
—
NC
05
—
NPA523
—
SC
Enumeration date
03/16/2006
Last updated
06/20/2024
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