Healthcare Provider Details

I. General information

NPI: 1467505016
Provider Name (Legal Business Name): CMC-NORTHEAST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16623 BIRKDALE PWKY SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE
HUNTERSVILLE NC
28078
US

IV. Provider business mailing address

16623 BIRKDALE PWKY SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE
HUNTERSVILLE NC
28078
US

V. Phone/Fax

Practice location:
  • Phone: 704-987-4277
  • Fax: 704-987-5096
Mailing address:
  • Phone: 704-987-4277
  • Fax: 704-987-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: FRIEDA M LOWDER
Title or Position: VP PHYSICIAN SERV
Credential:
Phone: 704-783-4146