Provider Demographics
NPI:1497716989
Name:CMC-NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC-NORTHEAST, INC.
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 1:219 LE PHILLIP CT NE
Mailing Address - Street 2:NORTHEAST LUNG ASSOCIATES
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2900
Mailing Address - Country:US
Mailing Address - Phone:704-403-7770
Mailing Address - Fax:704-403-7779
Practice Address - Street 1:219 LE PHILLIP CT NE
Practice Address - Street 2:NORTHEAST LUNG ASSOCIATES
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2900
Practice Address - Country:US
Practice Address - Phone:704-403-7770
Practice Address - Fax:704-403-7779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0109NOtherBCBS
NCDF8926OtherRAILROAD MEDICARE PTAN
4623036OtherAETNA
NC019H5OtherBCBS NC
2460072OtherAETNA
4855OtherPARTNERS
NC5908099Medicaid
NC890109NMedicaid
4623036OtherAETNA
NCDF8926OtherRAILROAD MEDICARE PTAN