Healthcare Provider Details

I. General information

NPI: 1518237825
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DRIVE SUITE 320
CONCORD NC
28025-0936
US

IV. Provider business mailing address

200 MEDICAL PARK DRIVE SUITE 320
CONCORD NC
28025-0936
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2777
  • Fax: 704-403-2779
Mailing address:
  • Phone: 704-403-2777
  • Fax: 704-403-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRIEDA M LOWDER
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 704-403-4146