Healthcare Provider Details

I. General information

NPI: 1376696062
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 CMNS PKWY SUITE 110, NE PEDIATRIC ENDO
HUNTERSVILLE NC
28078-5621
US

IV. Provider business mailing address

16623 BIRKDALE CMNS PKWY SUITE 110, NE PEDIATRIC ENDO
HUNTERSVILLE NC
28078-5621
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 Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

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