Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
ARDSLEY INTERNAL MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Authorized official
MRS. FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
1085 NORTHEAST GATEWAY CT, NE, SUITE 200-A, CONCORD, NC 28025-2412
(704) 403-8650
(704) 403-8655
Mailing address
1085 NORTHEAST GATEWAY CT, NE, SUITE 200-A, CONCORD, NC 28025-2412
(704) 403-8650
(704) 403-8655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01058
BCBS EFF PRIOR TO 7-1-07
NC
01
—
019FV
BCBS EFF 7-1-07
NC
01
—
344295
MAMSI GROUP NUMBER
NC
01
—
566000156042
TRICARE STANDARD, NON NWK
NC
05
—
5906964
—
NC
05
—
89012HK
—
NC
01
—
CC2854
RAILROAD MEDICARE GROUP
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
01
—
F827
PARTNERS MEDICARE CHOICE
NC
Enumeration date
05/26/2006
Last updated
10/19/2012
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