Provider Demographics
NPI:1376696062
Name:CMC-NORTHEAST, INC
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC
Other - Org Name:NE PEDIATRIC ENDOCRINOLOGY, HUNTERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES COORD
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:704-783-4146
Mailing Address - Street 1:16623 BIRKDALE CMNS PKWY
Mailing Address - Street 2:SUITE 110, NE PEDIATRIC ENDO
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5621
Mailing Address - Country:US
Mailing Address - Phone:704-987-4277
Mailing Address - Fax:704-987-5096
Practice Address - Street 1:16623 BIRKDALE CMNS PKWY
Practice Address - Street 2:SUITE 110, NE PEDIATRIC ENDO
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5621
Practice Address - Country:US
Practice Address - Phone:704-987-4277
Practice Address - Fax:704-987-5096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI902OtherPARTNERS MEDICARE CHOICE
NC355573OtherMAMSI
NC5903854Medicaid
NC566000156074OtherTRICARE STANDARD, NON NWK
NC015Y2OtherBCBS GROUP ID
NC4462028OtherAETNA