Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
NorthEast Women's Health & Obstetrics at Renaissance
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
2101 SHILOH CHURCH RD, SUITE 202, DAVIDSON, NC 28036-7603
(704) 439-3770
(704) 439-3779
Mailing address
2101 SHILOH CHURCH RD, SUITE 202, DAVIDSON, NC 28036-7603
(704) 439-3770
(704) 439-3779
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018FN
BCBS GROUP ID
NC
01
—
019F4
BCBS EFF 7-1-07
NC
01
—
355573
MAMSI
NC
01
—
566000156079
TRICARE
NC
05
—
5903802
—
NC
05
—
5906959
—
NC
01
—
CC2854
RAILROAD MEDICARE
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
01
—
K076
PARTNERS MEDICARE CHOICE
NC
Enumeration date
07/31/2006
Last updated
03/17/2014
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