Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
NorthEast Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Authorized official
FRIEDA M LOWDER (SR. VICE PRESIDENT)
(704) 403-4146
Entity
Organization
Contact information
Practice address
200 MEDICAL PARK DRIVE, SUITE 320, CONCORD, NC 28025-0936
(704) 403-2777
(704) 403-2779
Mailing address
200 MEDICAL PARK DRIVE, SUITE 320, CONCORD, NC 28025-0936
(704) 403-2777
(704) 403-2779
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232009
MEDICARE PTAN, GROUP
NC
05
—
5919313
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN, GROUP
NC
Enumeration date
01/03/2012
Last updated
03/28/2012
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