Novant Health Medical Group, LLC

Key facts

NPI: 1396751640
Entity type: Organization (NPI type 2)
Primary specialty: Dermatopathology Physician 207ND0900X
Legal business name: NOVANT HEALTH MEDICAL GROUP, LLC
Practice address: 9604 Holly Point Dr
Huntersville, NC 28078-4913
Phone: (704) 316-5070
Fax: (704) 316-5075
NPI assigned: Jul 31, 2006
Organization subpart: No

Authorized official

Name: Leea Jeanine Walton
Title: RCS Manager
Phone: (704) 316-6081

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Melinda Ruth Asfaw, PA-C Physician Assistant · Huntersville, NC · NPI 1568524023

NPD
Eric Alan Knuth, PA-C Physician Assistant · Huntersville, NC · NPI 1992259378

NPD
Jose Raul Pena, M.D. Dermatology Physician · Huntersville, NC · NPI 1598741563

NPD DERMATOLOGY
Regina Plohal, FNP Nurse Practitioner · Huntersville, NC · NPI 1932637634

NPD
Sonia Lau Sebastiano, P.A.-C Physician Assistant · Charlotte, NC · NPI 1386692408

NPD
Melissa Diane Wriglesworth, PA Physician Assistant · Huntersville, NC · NPI 1417438839

NPD

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
34D1058814	Novant Health Northlake Dermatology 9604 Holly Point Drive, Huntersville, NC 28078	Compliance	Feb 12, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NC

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20031121000692	NC	Part B Supplier - Clinic/Group Practice	1153234893	Receives reassigned benefits from 3,607 practitioners This NPI is an additional NPI on the enrollment

National Provider Directory

Locations

6324 Fairview Rd
Ste 200
Charlotte, NC 28210
Phone (704) 316-5070

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dermatology Physician Group: 193200000X MULTI-SPECIALTY GROUP	207N00000X
Dermatopathology Physician Group: 193200000X MULTI-SPECIALTY GROUP	207ND0900X			Yes

Addresses

Primary practice location

9604 Holly Point Dr
Huntersville, NC 28078-4913

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-5070

Other identifiers

Identifier	Type	State	Issuer
018GV	Other	NC	BCBS
NPB181	Medicaid	SC
5904331	Medicaid	NC

Other names

Novant Health Northlake Dermatology Doing business as

Other providers in Huntersville, NC

All providers in Huntersville, NC · Dermatopathology Physician in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.