Provider Demographics
NPI:1700075702
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:NORTHEAST NEUROLOGY -HUNTERSVILLE
Other - Org Type:Doing Business As
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 1:9625 NORTHCROSS CENTER CT
Mailing Address - Street 2:SUITE 102-F
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7348
Mailing Address - Country:US
Mailing Address - Phone:800-230-1721
Mailing Address - Fax:704-403-1901
Practice Address - Street 1:9625 NORTHCROSS CENTER CT
Practice Address - Street 2:SUITE 102-F
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7348
Practice Address - Country:US
Practice Address - Phone:800-230-1721
Practice Address - Fax:704-403-1901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-16
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908519Medicaid
NC019GNOtherBCBSNC
NCDF8926OtherRAILROAD MEDICARE PTAN
NC=========044OtherTRICARE
NC232009Medicare PIN