Organization
CMC-NORTHEAST, INC.
Active
Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
NORTHEAST PEDIATRIC ENDOCRINOLOGY
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 - NORTHEAST PEDIATRIC ENDOCRINOLOGY, CONCORD, NC 28025-2966
(704) 403-2660
(704) 403-2670
Mailing address
100 MEDICAL PARK DR, SUITE 310 - NORTHEAST PEDIATRIC ENDOCRINOLOGY, CONCORD, NC 28025-2966
(704) 403-2660
(704) 403-2670
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015Y2
BCBS EFF PRIOR TO 7-1-07
NC
01
—
019FT
BCBS EFF 7-1-07
NC
01
—
355573
MAMSI
NC
01
—
4462028
AETNA
NC
01
—
566000156020
TRICARE STANDARD, NON NWK
NC
05
—
5906953
—
NC
05
—
89015Y2
—
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
01
—
I092
PARTNERS MEDICARE CHOICE
NC
05
—
QPB690
—
SC
Enumeration date
06/05/2006
Last updated
11/18/2011
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