Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
Pediatric Pavilion at Huntersville
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERV)
(704) 403-4146
Entity
Organization
Contact information
Practice address
16623 BIRKDALE CMNS PKWY, SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE, HUNTERSVILLE, NC 28078-5621
(704) 987-4277
(704) 987-5096
Mailing address
16623 BIRKDALE CMNS PKWY, SUITE 110 PEDIATRIC PAVILION AT HUNTERSVILLE, HUNTERSVILLE, NC 28078-5621
(704) 987-4277
(704) 987-5096
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
355573
MAMSI
NC
01
—
566000156020
TRICARE STANDARD, NON NWK
NC
05
—
5904836
—
NC
05
—
5906850
—
NC
Enumeration date
01/18/2007
Last updated
02/05/2009
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