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General NPI Number Information
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NPI Number | 1023161726
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Entity Type | Organization
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Legal Business Name | CMC-NORTHEAST, INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 16623 BIRKDALE CMNS PKWY SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5621
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Country | US
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Telephone | 704-987-4277
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Fax | 704-987-5096
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Provider Business Mailing Address
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Address Line | 16623 BIRKDALE CMNS PKWY SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5621
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Country | US
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Telephone | 704-987-4277
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Fax | 704-987-5096
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Authorized Official
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Title or Position | VP PHYSICIAN SERV
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Name | FRIEDA M LOWDER
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Credential |
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Telephone | 704-403-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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