Healthcare Provider Details

I. General information

NPI: 1568608503
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR SUITE 250
CONCORD NC
28025-2982
US

IV. Provider business mailing address

200 MEDICAL PARK DR SUITE 250
CONCORD NC
28025-0933
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2740
  • Fax: 704-403-2744
Mailing address:
  • Phone: 704-403-2740
  • Fax: 704-403-2744

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 Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

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