Healthcare Provider Details

I. General information

NPI: 1073560850
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12925 HIGHWAY 601 SUITE 300
MIDLAND NC
28107-9535
US

IV. Provider business mailing address

12925 HIGHWAY 601 SUITE 300
MIDLAND NC
28107-9535
US

V. Phone/Fax

Practice location:
  • Phone: 704-888-3702
  • Fax: 704-888-4192
Mailing address:
  • Phone: 704-888-3702
  • Fax: 704-888-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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