Organization
CMC-NORTHEAST, INC.
Active
Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
COPPERFIELD INTERNAL MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
380 COPPERFIELD BLVD NE, COPPERFIELD INTERNAL MEDICINE, CONCORD, NC 28025-2402
(704) 403-2200
(704) 403-7264
Mailing address
380 COPPERFIELD BLVD NE, COPPERFIELD INTERNAL MEDICINE, CONCORD, NC 28025-2402
(704) 403-2200
(704) 403-7264
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019GT
BCBS EFF 7-1-07
NC
01
—
0226P
BCBS EFF PRIOR TO 7-1-07
NC
01
—
355573
MAMSI GROUP NUMBER
NC
01
—
4116
PARTNERS MEDICARE CHOICE
NC
01
—
566000156018
TRICARE STANDARD, NON NWK
NC
05
—
5906972
—
NC
05
—
890226P
—
NC
01
—
CC2854
RAILROAD MEDICARE
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
06/05/2006
Last updated
06/01/2010
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