Provider Demographics
NPI:1124075973
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3020 WEDDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8158
Mailing Address - Country:US
Mailing Address - Phone:704-403-7770
Mailing Address - Fax:704-403-7710
Practice Address - Street 1:3020 WEDDINGTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8158
Practice Address - Country:US
Practice Address - Phone:704-403-7770
Practice Address - Fax:704-403-7710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC2854OtherRAILROAD MEDICARE
NC01454OtherBCBS GROUP ID
NC566000156036OtherTRICARE STANDARD, NON NWK
NC019FHOtherBCBS EFF 7-1-07
NC7901454Medicaid
NCC572OtherPARTNERS MEDICARE CHOICE
NC5906960Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NC355573OtherMAMSI
NCCC2854OtherRAILROAD MEDICARE
NCC572OtherPARTNERS MEDICARE CHOICE
NC5906960Medicaid