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General NPI Number Information
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NPI Number | 1841513363
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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 | 03/11/2010
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 1001 BLYTHE BLVD SUITE 200D NORTHEAST PEDIATRIC PULMONLOGY-CHARLOTTE
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City | CHARLOTTE
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State | NC
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Zip | 28203-5866
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Country | US
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Telephone | 704-403-2660
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Fax | 704-403-2670
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Provider Business Mailing Address
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Address Line | 1001 BLYTHE BLVD SUITE 200D NORTHEAST PEDIATRIC PULMONLOGY-CHARLOTTE
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City | CHARLOTTE
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State | NC
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Zip | 28203-5866
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Country | US
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Telephone | 704-403-2660
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Fax | 704-403-2670
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Authorized Official
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Title or Position | SR VP
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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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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