Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
Development & Behavioral Pediatrics of the Carolina's
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
301 MEDICAL PARK DR, SUITE 202B, CONCORD, NC 28025-2981
(704) 403-2626
(704) 784-8615
Mailing address
301 MEDICAL PARK DR, SUITE 202B, CONCORD, NC 28025-2981
(704) 403-2626
(704) 784-8615
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016GN
BCBS GROUP ID
NC
01
—
396408
MAMSI GROUP NO
NC
01
—
561878722001
TRICARE STANDARD, NON NWK
NC
05
—
89135FE
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
01
—
QPB658
S.C. MEDICAID
SC
Enumeration date
04/05/2006
Last updated
11/07/2012
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