Provider Demographics
NPI:1942403787
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:NORTHEAST INTERNAL AND INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:707 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2975
Mailing Address - Country:US
Mailing Address - Phone:704-403-4050
Mailing Address - Fax:704-403-7059
Practice Address - Street 1:707 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2975
Practice Address - Country:US
Practice Address - Phone:704-403-4050
Practice Address - Fax:704-403-7059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-08
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906979Medicaid
NC019FJOtherBCBS EFF 7/1/07
NCDF8926OtherRAILROAD MEDICARE PTAN
NCDF8926OtherRAILROAD MEDICARE PTAN
NC5906979Medicaid