Provider Demographics
NPI:1245776889
Name:CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:NORTHEAST DIGESTIVE HEALTH CENTER EDISON SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-783-1840
Mailing Address - Street 1:1070 VINEHAVEN DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2438
Mailing Address - Country:US
Mailing Address - Phone:704-783-1840
Mailing Address - Fax:704-783-1850
Practice Address - Street 1:10030 EDISON SQUARE DR NW
Practice Address - Street 2:SUITE 204
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8308
Practice Address - Country:US
Practice Address - Phone:704-783-1840
Practice Address - Fax:704-783-1850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAS0104207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508279043Medicaid
NC8971386Medicaid
NC1194142422Medicaid
NC710009300Medicaid
NC891031VMedicaid
NC89136HKMedicaid
NC8926776Medicaid
NC5904428Medicaid
NC1396923322OtherNPI
NC89128WYMedicaid
NC8971386Medicaid
NC8926776Medicaid
NC1396923322OtherNPI