NOVANT MEDICAL GROUP INC (NPI# 1063753325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063753325 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP INC |
| Other Organization Name | NOVANT HEALTH SOUTHEAST OB/GYN |
| Practice Address |
1450 Matthews Township Pkwy Suite 300 Matthews NC 28105-2387 |
| Mailing Address |
Po Box 602362 Charlotte NC 28260-2362 |
| Practice Telephone | 7043211077 |
| Practice Fax Number | 7043211086 |
| Mailing Telephone | 7043211077 |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2013-05-22 |
| Authorized Official Name | GEOFFERY K GARDNER (V P FINANCE) |
| Authorized Official Telephone | 7043849094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Southeast OB/GYN | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700433711 | Novant Medical Group Inc | Psychiatry & Neurology | 933 Rockford St Ste 2, Mount Airy, NC 27030-5323 | 2019-08-23 |
| 1205481009 | Novant Medical Group Inc | Dermatology | 6324 Fairview Rd # 200, Charlotte, NC 28210-3271 | 2019-08-08 |
| 1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
| 1205355799 | Novant Medical Group Inc | Family Medicine | 16525 Holly Crest Ln Ste 250, Huntersville, NC 28078-4912 | 2017-09-15 |
| 1679090468 | Novant Medical Group Inc | Internal Medicine | 12311 Copper Way Ste 100, Charlotte, NC 28277-3643 | 2017-08-23 |
| 1003332016 | Novant Medical Group Inc | Internal Medicine | 10030 Gilead Rd Ste 344, Huntersville, NC 28078-7545 | 2017-08-22 |
| 1255709432 | Novant Medical Group Inc | Family Medicine | 19485 Old Jetton Road, Suite 100, Cornelius, NC 28031-6583 | 2015-09-04 |
| 1215326665 | Novant Medical Group Inc | Surgery | 819 N Atlantic Ave, Southport, NC 28461-3531 | 2015-01-22 |
| 1194113662 | Novant Medical Group Inc | Obstetrics & Gynecology | 1730 Kernersville Medical Parkway, Suite 104, Kernersville, NC 27284-7198 | 2015-01-06 |
| 1437556594 | Novant Medical Group Inc | Internal Medicine | 13 Medical Campus, Suite 102, Supply, NC 28462-4093 | 2014-12-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Novant Medical Group Inc. | 2626 Glenwood Ave Ste 550, Raleigh, NC 27608 |
| Virginia Business Entities | Novant Medical Group Inc. | 2085 Frontis Plaza Blvd, Winston Salem, North Carolina 27103 |
| Street Address |
1450 MATTHEWS TOWNSHIP PKWY SUITE 300 |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28105-2387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649273673 | Todd M Kopczynski | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 300, Matthews, NC 28105-2387 | 2005-05-23 |
| 1508393927 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy, Suite 320, Matthews, NC 28105-2387 | 2017-05-16 |
| 1932631850 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy, Suite 355, Matthews, NC 28105-2387 | 2017-03-30 |
| 1033566526 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 410, Matthews, NC 28105-2387 | 2016-05-16 |
| 1134506348 | Novant Health Matthews Medical Center | General Acute Care Hospital | 1450 Matthews Township Pkwy, Suite 150, Matthews, NC 28105-2387 | 2015-04-27 |
| 1053705418 | Suzanne Lake | Speech-Language Pathologist | 1450 Matthews Township Pkwy, Suite 150, Matthews, NC 28105-2387 | 2015-03-24 |
| 1386032647 | Leah Miles Alexander | Physician Assistant | 1450 Matthews Township Pkwy, Suite 250, Matthews, NC 28105-2387 | 2015-01-08 |
| 1225426976 | Novant Health Matthews Medical Center | General Acute Care Hospital | 1450 Matthews Township Pkwy, Suite 150, Matthews, NC 28105-2387 | 2015-01-05 |
| 1487906590 | Presbyterian Medical Care Corp | Emergency Medicine | 1450 Matthews Township Pkwy, Suite 170, Matthews, NC 28105-2387 | 2012-10-12 |
| 1588912562 | Surgical Specialists of Charlotte, Pa-matthews | Surgery | 1450 Matthews Township Pkwy, Suite 250, Matthews, NC 28105-2387 | 2012-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750917407 | Lauren Deasy Blackshaw | Counselor | 1163 Sam Newell Rd, Matthews, NC 28105 | 2020-03-13 |
| 1912549643 | Monarch | Community/Behavioral Health | 10545 Paces Avenue 634, Matthews, NC 28105 | 2019-10-15 |
| 1326515768 | Holly Harvey Heddleson | Nurse Practitioner | 1450 Matthews Township Pkwy Ste 280, Matthews, NC 28105 | 2018-10-24 |
| 1396241030 | Erickson Health Medical Group of North Carolina, PC | Internal Medicine | 2030 Windsor Run Lane, Matthews, NC 28105 | 2018-04-02 |
| 1811406994 | Lice Clinics of America of The Carolinas | Technician, Other | 3042 Suite C Senna Dr, Matthews, NC 28105 | 2017-09-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1568906055 | London Young | Physical Therapy Assistant | 11100- 11189 Berkley Square Ln, Charlotte, NC 28105 | 2016-12-19 |
| 1003363128 | New Beginnings Community Counseling Center | Community/Behavioral Health | 5232 Maragaret Wallace Road, Matthews, NC 28105 | 2016-09-07 |
| 1275993149 | Kristi Dougan | Nurse Practitioner | 434 N Trade St Ste 104, Matthews, NC 28105 | 2016-03-04 |
| 1205219896 | Kalyani Vellanki Starr | Dentist | 1819 Matthews Township Pkwy Ste 200, Matthews, NC 28105 | 2015-07-01 |
| Find all providers in zip 28105 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730313297 | Jillian M Johnston | Obstetrics & Gynecology | 1450 Matthews Township Parkway, Suite 300, Suite 300, Matthews, NC 28105-5332 | 2009-05-12 |
| 1538332077 | Latoya Nicole Walker | Obstetrics & Gynecology | 1450 Matthews Township Pkwy Ste 300, Matthews, NC 28105-5332 | 2008-04-04 |
| 1649273673 | Todd M Kopczynski | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 300, Matthews, NC 28105-2387 | 2005-05-23 |
| 1366837098 | Alexandra Boster | Obstetrics & Gynecology | 1450 Matthews Township Pkwy Ste 200, Matthews, NC 28105-2388 | 2015-03-31 |
| 1588950729 | Ebony Nicole Maddox Parson | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 200, Matthews, NC 28105-2387 | 2011-06-27 |
| 1639480569 | Peter S Salib | Obstetrics & Gynecology | 1450 Matthews Township Parkway, Suite 300, Matthews, NC 28105-5332 | 2010-06-25 |
| 1437288404 | Gregory Reynolds | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 200, Matthews, NC 28105-2387 | 2007-03-05 |
| 1992833958 | Philomena Salvemini | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 300, Matthews, NC 28105-2387 | 2007-03-01 |
| 1326176561 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Ste 300, Matthews, NC 28105-5332 | 2007-03-01 |
| 1043200264 | Michael Francis Sweeney | Obstetrics & Gynecology | 1450 Matthews Township Pkwy, Suite 200, Matthews, NC 28105-2387 | 2005-10-27 |
| Find all providers in MATTHEWS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.