Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
NorthEast Pediatric Pulmonology
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
FRIEDA M LOWDER (SR VP)
(704) 403-4146
Entity
Organization
Contact information
Practice address
100 MEDICAL PARK DR, PEDIATRIC PAVILION - SUITE 310, CONCORD, NC 28025-2948
(704) 403-2660
(704) 403-2670
Mailing address
100 MEDICAL PARK DR, PEDIATRIC PAVILION - SUITE 310, CONCORD, NC 28025-2948
(704) 403-2660
(704) 403-2670
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020C9
BCBS NC
NC
05
—
5909138
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
05
—
QPB689
—
SC
Enumeration date
02/22/2008
Last updated
11/15/2011
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