Provider Demographics
NPI:1477509735
Name:CMC-NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC-NORTHEAST, INC.
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 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 330, NORTHEAST RHEUMATOLOGY
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-403-1308
Mailing Address - Fax:704-403-1194
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 330, NORTHEAST RHEUMATOLOGY
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-403-1308
Practice Address - Fax:704-403-1194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019FYOtherBCBS EFF 7-1-07
NC566000156040OtherTRICARE STANDARD, NON NWK
NC0272KOtherBCBS EFF PRIOR TO 7-1-07
NCDF8926OtherRAILROAD MEDICARE PTAN
NC355573OtherMAMSI GROUP NUMBER
NC5906974Medicaid
NC7115OtherPARTNERS MEDICARE CHOICE
NCCC2854OtherRAILROAD MEDICARE GRP
NCDF8926OtherRAILROAD MEDICARE PTAN
NC5906974Medicaid
NC232009Medicare PIN