Provider Demographics
NPI:1013956028
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:NORTHEAST INFECTIOUS DISEASES
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:STE 208, NORTHEAST INFECTIOUS DISEASES
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-403-1766
Mailing Address - Fax:704-403-1096
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:STE 208, NORTHEAST INFECTIOUS DISEASES
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-403-1766
Practice Address - Fax:704-403-1096
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
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC2854OtherRAILROAD MEDICARE GROUP
NC019FXOtherBCBS EFF 7-1-07
NC355573OtherMAMSI GROUP
NC566000156002OtherTRICARE STANDARD, NON NWK
NC5906967Medicaid
NC7390OtherPARTNERS MEDICARE CHOICE
NCDF8926OtherRAILROAD MEDICARE PTAN
NC0233ROtherBCBS EFF PRIOR TO 7-1-07
NC890233RMedicaid
NCCC2854OtherRAILROAD MEDICARE GROUP
NC355573OtherMAMSI GROUP
NC566000156002OtherTRICARE STANDARD, NON NWK