Provider Demographics
NPI:1043363237
Name:CMC-NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:5427 HIGHWAY 49 S
Mailing Address - Street 2:NORTHEAST ENDOCRINOLOGY-HARRISBURG
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7408
Mailing Address - Country:US
Mailing Address - Phone:704-455-2065
Mailing Address - Fax:704-403-1357
Practice Address - Street 1:5427 HIGHWAY 49 S
Practice Address - Street 2:NORTHEAST ENDOCRINOLOGY-HARRISBURG
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7408
Practice Address - Country:US
Practice Address - Phone:704-455-2065
Practice Address - Fax:704-403-1357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019F1OtherBCBSNC
NC355573OtherMAMSI
NC5906982Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NC0147ROtherBCBS EFF PRIOR TO 7-1-07
NC566000156076OtherTRICARE STANDARD, NON NWK
NCCC2854OtherRAILROAD MEDICARE
NCCC2854OtherRAILROAD MEDICARE
NC2325363Medicare PIN
NC355573OtherMAMSI