Healthcare Provider Details

I. General information

NPI: 1841582566
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PARK DR SUITE 310E
CONCORD NC
28025-2966
US

IV. Provider business mailing address

100 MEDICAL PARK DR SUITE 310E
CONCORD NC
28025-2966
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2660
  • Fax: 704-403-2670
Mailing address:
  • Phone: 704-403-2660
  • Fax: 704-403-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

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