Healthcare Provider Details

I. General information

NPI: 1124075973
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WEDDINGTON RD
CONCORD NC
28027-8158
US

IV. Provider business mailing address

3020 WEDDINGTON RD
CONCORD NC
28027-8158
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-7770
  • Fax: 704-403-7710
Mailing address:
  • Phone: 704-403-7770
  • Fax: 704-403-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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