NOVANT MEDICAL GROUP, INC (NPI# 1366409492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1366409492 |
Entity Type | Organization |
Organization Name | NOVANT MEDICAL GROUP, INC |
Other Organization Name | NOVANT HEALTH PEDIATRIC NEUROLOGY |
Practice Address |
1900 Randolph Road Suite 1010 Charlotte NC 28207-1117 |
Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
Practice Telephone | 7043841390 |
Practice Fax Number | 7043841063 |
Mailing Telephone | 7043841390 |
Mailing Fax Number | 7043841063 |
Enumeration Date | 2006-05-01 |
Last Update Date | 2016-11-11 |
Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
Authorized Official Telephone | 7043841390 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2080P0008X |
Pediatrics Specialization: Neurodevelopmental Disabilities |
NC | Allopathic & Osteopathic Physicians | |
N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians | ||
Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | 5902989 | 05 | |
SC | NPB151 | 05 | |
NC | BCBS NC | 017U7 | 01 |
Other Name | Type Code |
---|---|
Novant Health Pediatric Neurology | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962048512 | Novant Medical Group, Inc | Family Medicine | 1400 Westgate Ctr Dr Ste 110, Winston Salem, NC 27103-3104 | 2019-11-19 |
1710444294 | Novant Medical Group, Inc | Orthopaedic Surgery | 167 Moore Rd Ste 202, King, NC 27021-8770 | 2019-02-21 |
1033698527 | Novant Medical Group, Inc | Internal Medicine | 8201 Healthcare Loop Ste 304, Charlotte, NC 28215 | 2018-08-07 |
1114411139 | Novant Medical Group, Inc | Internal Medicine | 8201 Healthcare Loop Ste 202, Charlotte, NC 28215-7072 | 2018-06-22 |
1649786575 | Novant Medical Group, Inc | Physical Therapist | 8045 Providence Rd Ste 100, Charlotte, NC 28277-8916 | 2017-12-14 |
1962953877 | Novant Medical Group, Inc | Internal Medicine | 9550 Rocky River Rd Ste 100, Charlotte, NC 28215 | 2016-10-17 |
1063963080 | Novant Medical Group, Inc | Urology | 1730 Kernersville Medical Pkwy Ste 303, Kernersville, NC 27284-7198 | 2016-10-14 |
1265807937 | Novant Medical Group, Inc | Orthopaedic Surgery | 1420 Us Highway 52, Suite B, Albemarle, NC 28001 | 2015-12-07 |
1881096907 | Novant Medical Group, Inc | Internal Medicine | 17810 Statesville Rd Ste 311, Cornelius, NC 28031-8149 | 2014-09-19 |
1548661606 | Novant Medical Group, Inc | Orthopaedic Surgery | 7138 Village Medical Circle, Clemmons, NC 27012 | 2014-09-09 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | NOVANT MEDICAL GROUP, INC. | 200 Hawthorne Ln, Charlotte, NC 28204-2515 |
Street Address |
1900 RANDOLPH ROAD SUITE 1010 |
City | CHARLOTTE |
State | NC |
Zip Code | 28207-1117 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619932746 | Joanna E York | Emergency Medicine | 1900 Randolph Road, Suite 900, Charlotte, NC 28207-1117 | 2006-04-20 |
1790910479 | Viranga Chamindi Pathiraja | Psychiatry & Neurology | 1900 Randolph Road, Suite 800, Charlotte, NC 28207-1110 | 2009-05-25 |
1962657353 | Novant Medical Group, Inc. | Psychiatry & Neurology | 1900 Randolph Road, Suite 300, Charlotte, NC 28207-1106 | 2008-11-26 |
1922182492 | Andrew Schulman | Surgery | 1900 Randolph Road, Ste 210, Charlotte, NC 28207-1106 | 2006-10-24 |
1588610471 | Novant Medical Group, Inc | Counselor | 1900 Randolph Road, Suite 800, Charlotte, NC 28207-1110 | 2006-05-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
Find all providers in zip 28207 |
Taxonomy Code | 2084N0402X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Neurology with Special Qualifications in Child Neurology |
A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
1023415981 | The Charlotte-mecklenburg Hospital Authority | Psychiatry & Neurology | 12311 Copper Way, Suite 200-a, Charlotte, NC 28277-3642 | 2014-11-20 |
1073932885 | Neurology Wellness, Pllc | Psychiatry & Neurology | 10508 Park Rd, Ste 130, Charlotte, NC 28210-8525 | 2014-04-09 |
1780011825 | The Charlotte-mecklenburg Hospital Authority | Psychiatry & Neurology | 2608 E 7th St, Charlotte, NC 28204-4375 | 2013-10-03 |
1518394659 | The Charlotte-mecklenburg Hospital Authority | Psychiatry & Neurology | 101 E W T Harris Blvd, Bldg 3000 Ste 3301b, Charlotte, NC 28262-3485 | 2013-10-03 |
1720415946 | The Charlotte-mecklenburg Hospital Authority | Psychiatry & Neurology | 1001 Blythe Blvd, Ste 200, Charlotte, NC 28203-5866 | 2013-10-02 |
1922367077 | Carolinas Medical Center-northeast | Psychiatry & Neurology | 4501 Cameron Valley Pkwy, Suite 301-a, Charlotte, NC 28211-4297 | 2012-05-10 |
1699060384 | Carolinas Medical Center-northeast | Psychiatry & Neurology | 101 E W T Harris Blvd, Bldg 3000, Suite 3301b, Charlotte, NC 28262-7000 | 2011-06-10 |
1972806321 | Cmc-northeast, Inc. | Psychiatry & Neurology | 1001 Blythe Blvd, Suite 200 Cpnc - Charlotte Specialty Center, Charlotte, NC 28203-5866 | 2010-12-07 |
1265747497 | Cmc-northeast, Inc. | Psychiatry & Neurology | 1010 Edgehill Rd N, Carolinas Pediatric Neurology Care - Charlotte, Charlotte, NC 28207-1885 | 2010-08-12 |
Find all providers in CHARLOTTE |
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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.