Provider Demographics
NPI:1265764443
Name:CMC-NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP
Authorized Official - Prefix:MRS
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 1:10030 EDISON SQUARE DR NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8252
Mailing Address - Country:US
Mailing Address - Phone:704-403-7830
Mailing Address - Fax:704-403-7840
Practice Address - Street 1:10030 EDISON SQUARE DR NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8252
Practice Address - Country:US
Practice Address - Phone:704-403-7830
Practice Address - Fax:704-403-7840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE PTAN, GROUP
NC5914718Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN