Healthcare Provider Details

I. General information

NPI: 1336380294
Provider Name (Legal Business Name): CMC-NORTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N OB/GYN HOSPITALISTS
CONCORD NC
28025-2927
US

IV. Provider business mailing address

920 CHURCH ST N OB/GYN HOSPITALISTS
CONCORD NC
28025-2927
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1632
  • Fax: 704-403-1356
Mailing address:
  • Phone: 704-403-1632
  • Fax: 704-403-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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