Provider Demographics
NPI:1386683472
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:NORTHEAST ENDOCRINOLOGY
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:704-403-4146
Mailing Address - Street 1:1085 NORTHEAST GATEWAY COURT, NE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2406
Mailing Address - Country:US
Mailing Address - Phone:704-403-8320
Mailing Address - Fax:704-403-8321
Practice Address - Street 1:1085 NORTHEAST GATEWAY COURT, NE
Practice Address - Street 2:SUITE 330
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-403-8320
Practice Address - Fax:704-403-8321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC355573OtherMAMSI
NCCC2854OtherRAILROAD MEDICARE
NCDF8926OtherRAILROAD MEDICARE PTAN
NC0147ROtherBCBS EFF PRIOR TO 7-1-07
NC566000156025OtherTRICARE STANDARD, NON NWK
NC890147RMedicaid
NC7368OtherPARTNERS MEDICARE CHOICE
NC019F1OtherBCBS EFF 7-1-07
NC5906970Medicaid
NCCC2854OtherRAILROAD MEDICARE
NC=========010OtherTRICARE EFFECTIVE 7/1/07
NCDF8926OtherRAILROAD MEDICARE PTAN