=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386683472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINAS MEDICAL CENTER-NORTHEAST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2006
-----------------------------------------------------
Last Update Date | 08/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1085 NORTHEAST GATEWAY COURT, NE SUITE 330
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-403-8320
-----------------------------------------------------
Fax | 704-403-8321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1085 NORTHEAST GATEWAY COURT, NE SUITE 330
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-403-8320
-----------------------------------------------------
Fax | 704-403-8321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP PHYSICIAN SERVICES
-----------------------------------------------------
Name | FRIEDA M LOWDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-403-4146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------