Provider Demographics
NPI:1346308517
Name:CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:NORTHEAST DIGESTIVE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
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
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 1:1070 VINEHAVEN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2438
Practice Address - Country:US
Practice Address - Phone:704-783-1840
Practice Address - Fax:704-783-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01163OtherBCBS OF NORTH CAROLINA
NC3409843Medicaid
NC3409843Medicaid