Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
Edison Square Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
MRS. FRIEDA M LOWDER (SR. VP)
(704) 403-4146
Entity
Organization
Contact information
Practice address
10030 EDISON SQUARE DR NW, SUITE 100, CONCORD, NC 28027-8252
(704) 403-7830
(704) 403-7840
Mailing address
10030 EDISON SQUARE DR NW, SUITE 100, CONCORD, NC 28027-8252
(704) 403-7830
(704) 403-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232009
MEDICARE PTAN, GROUP
NC
05
—
5914718
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
02/12/2010
Last updated
09/09/2010
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