Provider Demographics
NPI:1508293879
Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:NORTHEAST PLASTIC & RECONSTRUCTIVE SURGERY-ALBEMARLE
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:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-1780
Mailing Address - Street 1:105 YADKIN STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3459
Mailing Address - Country:US
Mailing Address - Phone:704-403-2670
Mailing Address - Fax:704-403-2779
Practice Address - Street 1:105 YADKIN STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3459
Practice Address - Country:US
Practice Address - Phone:704-403-2670
Practice Address - Fax:704-403-2779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-02
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC904Medicare PIN