Healthcare Provider Details

I. General information

NPI: 1730128810
Provider Name (Legal Business Name): CMC-NORTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR SUITE 550 CONCORD INTERNAL MEDICINE
CONCORD NC
28025-0926
US

IV. Provider business mailing address

200 MEDICAL PARK DR SUITE 550 CONCORD INTERNAL MEDICINE
CONCORD NC
28025-0926
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1307
  • Fax: 704-403-1090
Mailing address:
  • Phone: 704-403-1307
  • Fax: 704-403-1090

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 Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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