Provider Demographics
NPI:1730128810
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:CONCORD INTERNAL MEDICINE
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 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 550 CONCORD INTERNAL MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0926
Mailing Address - Country:US
Mailing Address - Phone:704-403-1307
Mailing Address - Fax:704-403-1090
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 550 CONCORD INTERNAL MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0926
Practice Address - Country:US
Practice Address - Phone:704-403-1307
Practice Address - Fax:704-403-1090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC355573OtherMAMSI GROUP NUMBER
NCCC2854OtherRAILROAD MEDICARE GROUP
NC5906973Medicaid
NC0279NOtherBCBS EFF PRIOR TO 7-1-07
NC019FPOtherBCBS EFF 7-1-07
NC7232OtherPARTNERS MEDICARE CHOICE
NC890279NMedicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NC566000156022OtherTRICARE STANDARD, NON NWK
NC5906973Medicaid
NC232009Medicare PIN
NC7232OtherPARTNERS MEDICARE CHOICE