NOVANT MEDICAL GROUP, INC. (NPI# 1396751640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396751640 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH NORTHLAKE DERMATOLOGY |
| Practice Address |
9604 Holly Point Dr Huntersville NC 28078-4913 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043165070 |
| Practice Fax Number | 7043165075 |
| Mailing Telephone | 7043165070 |
| Mailing Fax Number | 7043165075 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-11-29 |
| Authorized Official Name | GEOFFREY GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043849144 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | NPB181 | 05 | |
| NC | 5904331 | 05 | |
| NC | BCBS | 018GV | 01 |
| Other Name | Type Code |
|---|---|
| Novant Health Northlake Dermatology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033723531 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy Ste 320, Matthews, NC 28105-2389 | 2020-09-02 |
| 1346868155 | Novant Medical Group, Inc. | Family Medicine | 106 Corporate Park Dr Ste 200, Mooresville, NC 28117-7134 | 2020-07-08 |
| 1861019150 | Novant Medical Group, Inc. | Family Medicine | 2701 Statesville Ave., Charlotte, NC 28206 | 2020-07-02 |
| 1932725124 | Novant Medical Group, Inc. | Internal Medicine | 125 Queens Rd Ste 510, Charlotte, NC 28204-3215 | 2020-06-23 |
| 1922645571 | Novant Medical Group, Inc. | Surgery | 6324 Fairview Rd Ste 420, Charlotte, NC 28210-3372 | 2019-12-03 |
| 1437706256 | Novant Medical Group, Inc. | Physical Therapist | 11202 Harris Rd, Huntersville, NC 28078-7633 | 2019-08-26 |
| 1336795137 | Novant Medical Group, Inc. | Surgery | 3515 W Market St Ste 310, Greensboro, NC 27403-4438 | 2019-08-16 |
| 1104472125 | Novant Medical Group, Inc. | Neurological Surgery | 3515 W Market St Ste 210, Greensboro, NC 27403-4442 | 2019-08-15 |
| 1649824954 | Novant Medical Group, Inc. | Family Medicine | 6555 Kee Lane, Harrisburg, NC 28075-7463 | 2019-07-25 |
| 1285287185 | Novant Medical Group, Inc. | Lactation Consultant, Non-RN | 6324 Fairview Rd Ste 435, Charlotte, NC 28210-4278 | 2019-07-19 |
| 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 |
9604 HOLLY POINT DR |
| City | HUNTERSVILLE |
| State | NC |
| Zip Code | 28078-4913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487641429 | Advanced Dermatology Center, Pa | Dermatology | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2005-10-04 |
| 1417438839 | Melissa Wriglesworth | Physician Assistant | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2018-08-23 |
| 1932637634 | Regina Diane Augter | Nurse Practitioner | 9604 Holly Point Dr, Huntersville, NC 28078 | 2017-05-25 |
| 1992259378 | Eric Alan Knuth | Physician Assistant | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2016-08-15 |
| 1699953166 | Erin S. Dice | Physician Assistant | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2008-02-06 |
| 1568524023 | Melinda Ruth Asfaw | Physician Assistant | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2006-12-14 |
| 1447266796 | Jean Marie Kois | Dermatology | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2006-07-31 |
| 1396790317 | Colene Marie Calo | Dermatology | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2006-05-25 |
| 1043296817 | Mary M Cummins | Physician Assistant | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2005-12-22 |
| 1598741563 | Jose Raul Pena | Dermatology | 9604 Holly Point Dr, Huntersville, NC 28078-4913 | 2005-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538787718 | John M. Bakarich, Dds, Pllc | Dentist | 15810 Northcross Drive, Suite A, Huntersville, NC 28078 | 2020-07-14 |
| 1316587082 | Blake Allen Klessig | Chiropractor | 8936 Northpointe Executive Park Dr, Suite 195, Huntersville, NC 28078 | 2020-01-10 |
| 1922644830 | Steven James Underwood | Physical Therapist | Aldersgate Ccrc, 3800 Shamrock Drive, Charlotte, NC 28078 | 2019-11-26 |
| 1851856306 | Jessica Runnion | Behavior Technician | 14625 Reese Blvd, Apartment 208, Huntersville, NC 28078 | 2019-02-08 |
| 1568935401 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 111 Commerce Centre Drive, Suite 305, Huntersville, NC 28078 | 2019-01-03 |
| 1932691763 | Shakira Grier | Massage Therapist | 15905 Brookway Drive, Ste 4202, Huntersville, NC 28078 | 2018-06-06 |
| 1457850596 | Chudney Drew | Counselor | 10224 Hickorywood Hill Ave Ste 201, Huntersville, NC 28078 | 2018-02-05 |
| 1215457122 | Amy Nicole Castongia | Counselor | 10511 Drake Hill Dr, Huntersville, NC 28078 | 2017-06-21 |
| 1457714057 | Robin D Disbro | Registered Nurse | 6216 Colonial Garden Drive, Huntersville, NC 28078 | 2016-03-31 |
| 1144695545 | Huntersville H&r Ops Limited Partnership | Skilled Nursing Facility | 13835 Boren Street, Huntersville, NC 28078 | 2015-12-10 |
| Find all providers in zip 28078 | ||||
| Taxonomy Code | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073667077 | Earl George Gross | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1972591055 | Paul J Kostuchenko | Dermatology | 1345 Westgate Center Dr Ste B, Winston Salem, NC 27103-3041 | 2005-10-12 |
| 1588959894 | Dana Haydel | Dermatology | 706 Green Valley Rd Ste 104, Greensboro, NC 27408 | 2011-06-14 |
| 1821240995 | Westgate Dermatology and Laser Center, P.a. | Dermatology | 2020 Peace Haven Rd, Winston Salem, NC 27106-4851 | 2008-10-21 |
| 1841344843 | Crystal Coast Dermatology Services, Pa | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1609961853 | Scott David Mcclellan | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-10-04 |
| 1962411017 | Hee Kim Park | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2006-08-07 |
| 1104847714 | Polley Clinic of Dermatology & Dermatologic Surgery | Dermatology | 1806 Glendale Dr Sw, Wilson, NC 27893-4402 | 2006-07-21 |
| 1619903176 | Dermatology Associates of Coastal Carolina, Pa | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-06-24 |
| 1255316311 | Rita O Pichardo-geisinger | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-13 |
| Find all providers with the same taxonomy | ||||
| City | HUNTERSVILLE |
| Zip Code | 28078 |
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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.