Provider Demographics
NPI:1306181128
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:GYN CARE OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:10030 EDISON SQUARE DR
Mailing Address - Street 2:100-A
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8252
Mailing Address - Country:US
Mailing Address - Phone:704-403-7670
Mailing Address - Fax:704-403-7671
Practice Address - Street 1:10030 EDISON SQUARE DR
Practice Address - Street 2:100-A
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8252
Practice Address - Country:US
Practice Address - Phone:704-403-7670
Practice Address - Fax:704-403-7671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-05
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922045Medicaid
NC5922045Medicaid