Provider Demographics
NPI:1104865112
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:CAROLINA INTERNAL MEDICINE-CONCORD
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 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-403-3676
Mailing Address - Fax:704-403-3666
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-403-3676
Practice Address - Fax:704-403-3666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901373Medicaid
NCCN2098OtherRAILROAD GROUP ID
NCJ386OtherPARTNERS MEDICARE CHOICE
NCDF8926OtherRAILROAD MEDICARE PTAN
NC355573OtherMAMSI GROUP ID
NC566000156065OtherTRICARE
NC017EWOtherBCBS EFF PRIOR TO 7-1-07
NC019F2OtherBCBSNC
NC5906962Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NC5901373Medicaid