Provider Demographics
NPI:1245383967
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:ARDSLEY INTERNAL MEDICINE-HARRISBURG
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:704-402-4146
Mailing Address - Street 1:5427 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7408
Mailing Address - Country:US
Mailing Address - Phone:704-454-7360
Mailing Address - Fax:704-454-7377
Practice Address - Street 1:5427 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7408
Practice Address - Country:US
Practice Address - Phone:704-454-7360
Practice Address - Fax:704-454-7377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF827OtherPARTNERS MEDICARE CH
NC019FVOtherBCBSNC 7-1-07
NC344295OtherMAMSI GROUP NUMBER
NC566000156051OtherTRICARE STANDARD, NON NWK
NC5906963Medicaid
NCCC2854OtherRAILROAD MEDICARE GROUP
NCDF8926OtherRAILROAD MEDICARE PTAN
NC01058OtherBCBSNC PRIOR TO 7-1-07
NC89013W3Medicaid
NC89013W3Medicaid
NC5906963Medicaid