Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
CAROLINA PEDIATRIC SURGERY
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
100 MEDICAL PARK DR, SUITE 310 -CAROLINA PEDIATRIC SURGERY, CONCORD, NC 28025-2966
(704) 403-2660
(704) 403-2670
Mailing address
100 MEDICAL PARK DR, SUITE 310 -CAROLINA PEDIATRIC SURGERY, CONCORD, NC 28025-2966
(704) 403-2660
(704) 403-2670
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017CP
BCBS EFF PRIOR TO 7-1-07
NC
01
—
019FN
BCBS EFF 7-1-07
NC
01
—
241255803
TRICARE
NC
01
—
355573
MAMSI
NC
05
—
5901473
—
NC
05
—
5906961
—
NC
01
—
7878267
AETNA
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
05
—
QPB706
—
SC
Enumeration date
06/05/2006
Last updated
11/15/2011
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