Provider Demographics
NPI:1265607493
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: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:704-403-4146
Mailing Address - Street 1:2101 SHILOH CHURCH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7601
Mailing Address - Country:US
Mailing Address - Phone:704-403-8650
Mailing Address - Fax:704-403-8655
Practice Address - Street 1:2101 SHILOH CHURCH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7601
Practice Address - Country:US
Practice Address - Phone:704-403-8650
Practice Address - Fax:704-403-8655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDF8926OtherRAILROAD MEDICARE PTAN
NC019FVOtherBCBSNC
NC5950094Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN