Organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Active
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEAST
Other names
NORTHEAST NEUROLOGY
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
315 MEDICAL PARK DR, SUITE 202, CONCORD, NC 28025-2973
(704) 403-1911
(704) 403-1901
Mailing address
315 MEDICAL PARK DR, SUITE 202, CONCORD, NC 28025-2973
(704) 403-1911
(704) 403-1901
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01895
BCBS EFF PRIOR TO 7-1-07
NC
01
—
019GN
BCBS EFF 7-1-07
NC
01
—
355573
MAMSI
NC
01
—
566000156023
TRICARE STANDARD, NON NWK
NC
05
—
5906955
—
NC
05
—
7901895
—
NC
01
—
8599
PARTNERS MEDICARE CHOICE
NC
01
—
CC2854
RAILROAD MEDICARE
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
05/26/2006
Last updated
03/15/2013
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