Provider Demographics
NPI:1093762627
Name:CMC - NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC - NORTHEAST, INC.
Other - Org Name:NORTHEAST INTERNAL MEDICINE
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:704-783-4146
Mailing Address - Street 1:130 LAKE CONCORD RD NE
Mailing Address - Street 2:SUITE B NE INTERNAL MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1918
Mailing Address - Country:US
Mailing Address - Phone:704-652-7270
Mailing Address - Fax:704-788-1935
Practice Address - Street 1:130 LAKE CONCORD RD NE
Practice Address - Street 2:SUITE B NE INTERNAL MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1918
Practice Address - Country:US
Practice Address - Phone:704-652-7270
Practice Address - Fax:704-788-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC355573OtherMAMSI
NC566000156041OtherTRICARE STANDARD, NON NWK
NCF158OtherPARTNERS MEDICARE CHOICE
NCCC2854OtherRAILROAD MEDICARE
NC011XFOtherBCBS GROUP ID
NC89011XFMedicaid
NC011XFOtherBCBS GROUP ID