Provider Demographics
NPI:1457679672
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:NORTHEAST NEUROLOGY - DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP
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 1:1585 FORNEY CREEK PKWY
Mailing Address - Street 2:SUITE 2200 NORTHEAST NEUROLOGY - DENVER
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9514
Mailing Address - Country:US
Mailing Address - Phone:704-403-1911
Mailing Address - Fax:704-403-1901
Practice Address - Street 1:1585 FORNEY CREEK PKWY
Practice Address - Street 2:SUITE 2200 NORTHEAST NEUROLOGY - DENVER
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9514
Practice Address - Country:US
Practice Address - Phone:704-403-1911
Practice Address - Fax:704-403-1901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-12
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDF8926OtherRAILROAD MEDICARE
NC232009OtherMEDICARE PTAN, GROUP
NC5915569Medicaid