Organization
CMC-NORTHEAST, INC
Active
Other names
NE Pediatric Neurology, Huntersville
Organization subpart
No
Provider details
NPI number
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERV)
(704) 783-4146
Entity
Organization
Contact information
Practice address
16623 BIRKDALE PWKY, SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE, HUNTERSVILLE, NC 28078
(704) 987-4277
(704) 987-5096
Mailing address
16623 BIRKDALE PWKY, SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE, HUNTERSVILLE, NC 28078
(704) 987-4277
(704) 987-5096
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015Y1
BCBS GROUP ID
NC
01
—
3555573
MAMSI
NC
01
—
566000156075
TRICARE STANDARD, NON NWK
NC
05
—
5903854
—
NC
01
—
7837542
AETNA
NC
01
—
I912
PARTNERS MEDICARE CHOICE
NC
Enumeration date
01/18/2007
Last updated
08/22/2007
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