Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
CAROLINAS PEDIATRIC NEUROLOGY CARE - CONCORD
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
100 MEDICAL PARK DR, SUITE 310, CONCORD, NC 28025-2948
(704) 403-2660
(704) 403-2670
Mailing address
100 MEDICAL PARK DR, SUITE 310, CONCORD, NC 28025-2948
(704) 403-2660
(704) 403-2670
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015Y1
BCBS GROUP ID
NC
01
—
019FG
BCBS EFF 7-1-07
NC
01
—
355573
MAMSI
NC
01
—
566000156020
TRICARE STANDARD, NON NWK
NC
05
—
5906952
—
NC
01
—
7837542
AETNA
NC
05
—
89015Y1
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
01
—
I912
PARTNERS MEDICARE CHOICE
NC
05
—
NPB455
—
SC
Enumeration date
05/26/2006
Last updated
07/31/2013
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