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NOVANT MEDICAL GROUP INC. NPI 1003966185


NPI Information

NPI: 1003966185
Provider Name: NOVANT MEDICAL GROUP, INC.

Doing Business As: NOVANT HEALTH PEDIATRIC GASTROENTEROLOGY

Classification: Pediatrics - 2080P0206X
Entity Type: Organization

Specialization: Pediatric Gastroenterology

CLIA Number: 34D1067428

Address:
2711 RANDOLPH RD
SUITE 301
CHARLOTTE, NC
ZIP 28207
Phone: (704) 316-5060
Get Directions

NOVANT MEDICAL GROUP, INC. is a pediatric gastroenterology pediatrics in Charlotte, NC. The provider is a pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. NOVANT MEDICAL GROUP, INC. NPI is 1003966185. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Novant Health Pediatric Gastroenterology.

The provider's business location address is:

2711 RANDOLPH RD
SUITE 301
CHARLOTTE, NC
ZIP 28207-027
Phone: (704) 316-5060
Fax: (704) 316-5069

The provider's authorized official is Shala Davis .
The authorized official title is Rcs Manager and has the following contact phone number (704) 303-7517.

The CLIA number assigned to this NPI record is 34D1067428 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/11/2007 and was last updated on 8/16/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080P0206XPediatricsPediatric GastroenterologyNORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1018WHOTHERNORTH CAROLINABCBS NC
2NPB219MEDICAIDSOUTH CAROLINA
35905866MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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