Individual provider Active NPI

Mausumi Lidogoster, M.D.

  • Neurology Physician
  • Charlotte, NC
National Provider Identifier
1306042650
Registry record updated Mar 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2013-00634 Issued in NC
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

Updated by the provider on Mar 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

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. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA11311600NJMDNeuromuscular Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Neurology CurrentSince Jul 4, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jul 4, 2023 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.