Carolinas Medical Center-Northeast

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CAROLINAS MEDICAL CENTER-NORTHEAST

Doing business as

NorthEast Dermatology-Salisbury

Practice address

340 Jake Alexander Blvd W
Suite B
Salisbury, NC 28147-1364

Phone

(704) 403-2777

Fax

(704) 403-2779

NPI assigned

Jul 20, 2012

Last updated

Oct 19, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

CAROLINAS MEDICAL CENTER-NORTHEASTAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Frieda Miller Lowder

Title

Sr Vice President

Phone

(704) 403-4146

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• NorthEast Dermatology-Salisbury Doing business as

Part of

CMC-Northeast Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Carolinas Medical Center-Northeast

  • Internal Medicine Physician
  • Concord, NC
  • NPI 1740241801
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Walter Lee Fanning Jr., M.D.

  • Infectious Disease Physician
  • Concord, NC
  • NPI 1639146780
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1003161555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 JAKE ALEXANDER BLVD W",
            "address_2": "SUITE B",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471364",
            "telephone_number": "704-403-2777",
            "fax_number": "704-403-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 JAKE ALEXANDER BLVD W",
            "address_2": "SUITE B",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471364",
            "telephone_number": "704-403-2777",
            "fax_number": "704-403-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "enumeration_date": "2012-07-20",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "MILLER",
        "authorized_official_title_or_position": "SR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921378",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN, GROUP",
            "identifier": "232009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthEast Dermatology-Salisbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolina Oncology Associates (William M Brinkley MD)
• Carolina Pain and Weight Loss, PA
• Carolina Spine & Hand Center PA
• Carolina Women's Health Associates, PA
• Carolinas Depression Clinic PLLC
• Carolinas Medical Center-Northeast (SouthPoint Internal Medicine)
• Carolinas Medical Center-Northeast (NorthEast Endocrinology-Salisbury)
• Carolinas Medical Supply LLC
• Carolinas Physicians Network Inc (Atrium Health Urgent Care)
• Carolinas Physicians Network Inc (The Sanger Clinic)

• Dermatology Physician in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.