Healthcare Provider Details

I. General information

NPI: 1285950790
Provider Name (Legal Business Name): CMC-NORTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 COOK ST
MT PLEASANT NC
28124-7686
US

IV. Provider business mailing address

8560 COOK ST
MT PLEASANT NC
28124-7686
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1911
  • Fax: 704-403-1901
Mailing address:
  • Phone: 704-403-1911
  • Fax: 704-403-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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