Active NPI
Mausumi Lidogoster, M.D.
- Neurology Physician
- Charlotte, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 2013-00634
- Practice address
- 200 Hawthorne LN
Charlotte, NC 28204-2515 - Phone
- (704) 384-5729
- Fax
- (704) 316-9639
- NPI assigned
- Jun 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromuscular Medicine (Psychiatry & Neurology) Physician | 2084N0008X | 25MA11311600 | NJ | |
| Neurology Physician | 2084N0400X | 252677 | NY | |
| Clinical Neurophysiology Physician | 2084N0600X | 2013-00634 | NC | |
| Neurology Physician | 2084N0400X | 2013-00634 | NC | Primary |
Addresses
Primary practice location
200 Hawthorne LN
Charlotte, NC 28204-2515
Mailing address
2429 Maynard Rd
Charlotte, NC 28270-0753
Phone (914) 374-4243
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mlidogoster40211@direct.novanthealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA11311600 | NJ | MD | Neuromuscular Medicine (Psychiatry & Neurology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Novant Health Medical Group, LLC | Neurology | Current | Accepting new patients |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Clinical Neurophysiology | Current | Accepting new patients |
Locations
1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437
15033 Ballancroft Pkwy
Ste 200
Charlotte, NC 28277
Phone (704) 316-2920
200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424
5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441
190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200
2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300
Interoperability endpoints
- mlidogoster40211@direct.novanthealth.org
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Neurology with Special Qualifications in Child Neurology Physician
- Charlotte, NC
- NPI 1366409492
Clinical Neurophysiology
-
- Obstetrics & Gynecology Physician
- Matthews, NC
- NPI 1386506137
-
- Neurology Physician
- Waxhaw, NC
- NPI 1578056057
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1306042650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2429 MAYNARD RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282700753",
"telephone_number": "914-374-4243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWTHORNE LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042515",
"telephone_number": "704-384-5729",
"fax_number": "704-316-9639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDOGOSTER",
"first_name": "MAUSUMI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-25",
"last_updated": "2022-03-17",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0008X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neuromuscular Medicine",
"state": "NJ",
"license": "25MA11311600",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "252677",
"primary": false
},
{
"code": "2084N0600X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": "NC",
"license": "2013-00634",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NC",
"license": "2013-00634",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mlidogoster40211@direct.novanthealth.org",
"affiliation": "N",
"address_1": "1401 Matthews Township Pkwy",
"address_2": "Ste 212",
"city": "Matthews",
"state": "NC",
"country_code": "US",
"postal_code": "281055402",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.