Healthcare Provider Details

I. General information

NPI: 1689969370
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E W T HARRIS BLVD BLDG 3000, SUITE 3301D
CHARLOTTE NC
28262-7000
US

IV. Provider business mailing address

101 E W T HARRIS BLVD BLDG 3000, SUITE 3301D
CHARLOTTE NC
28262-7000
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2660
  • Fax: 704-403-2670
Mailing address:
  • Phone: 704-403-2660
  • Fax: 704-403-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRIEDA M LOWDER
Title or Position: SR VP
Credential:
Phone: 704-403-4146