Provider Demographics
NPI:1003855016
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:NORTHEAST ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:100 MEDICAL PARK DR
Mailing Address - Street 2:STE 110, NORTHEAST ONCOLOGY ASSOCIATES
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2948
Mailing Address - Country:US
Mailing Address - Phone:704-403-1370
Mailing Address - Fax:704-403-1389
Practice Address - Street 1:100 MEDICAL PARK DR
Practice Address - Street 2:STE 110, NORTHEAST ONCOLOGY ASSOCIATES
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2948
Practice Address - Country:US
Practice Address - Phone:704-403-1370
Practice Address - Fax:704-403-1389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC2854OtherRAILROAD MEDICARE
NC0114WOtherBCBS EFF PRIOR TO 7-1-07
NCDF8926OtherRAILROAD MEDICARE PTAN
NC019GPOtherBCBS EFF 7-1-07
NC566000156031OtherTRICARE STANDARD, NON NWK
NC5906954Medicaid
NC7233OtherPARTNERS MEDICARE
NC355573OtherMAMSI
NC890114WMedicaid
NC0114WOtherBCBS EFF PRIOR TO 7-1-07
NC5906954Medicaid
NC2325363Medicare PIN