Provider Demographics
NPI:1154578417
Name:CMC - NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC - NORTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
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 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 430 CONCORD WOMEN'S SPECIALTY
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-792-1000
Mailing Address - Fax:704-792-1004
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 430 CONCORD WOMEN'S SPECIALTY
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-792-1000
Practice Address - Fax:704-792-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC - NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009Medicare PIN