NPIMap

Organization Active NPI

Carolinas Medical Center-Northeast

  • Developmental - Behavioral Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1144580754
Registry record updated Jul 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Practice address
4501 Cameron Valley Pkwy
Suite 301-B
Charlotte, NC 28211-4297
Phone
(704) 403-2626
Fax
(704) 403-6949
NPI assigned
May 17, 2012
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEASTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2013

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

Authorized official

Name
Frieda M Lowder
Title
Sr. Vice President
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0006X Primary

Addresses

Primary practice location

4501 Cameron Valley Pkwy
Suite 301-B
Charlotte, NC 28211-4297

Mailing address

4501 Cameron Valley Pkwy
Suite 301-B
Charlotte, NC 28211-4297
Phone (704) 403-2626

Other identifiers 1

IdentifierTypeStateIssuer
5921007MedicaidNC

Other names 1

  • Development & Behavioral Pediatrics of the Carolina's-Charlotte Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC Northeast44 organizations share this tax ID, including this one
Part of
CMC Northeast

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

4501 Cameron Valley Pkwy
Ste 301B
Charlotte, NC 28211
Phone (704) 403-2626

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1144580754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY",
            "address_2": "SUITE 301-B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114297",
            "telephone_number": "704-403-2626",
            "fax_number": "704-403-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY",
            "address_2": "SUITE 301-B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114297",
            "telephone_number": "704-403-2626",
            "fax_number": "704-403-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "enumeration_date": "2012-05-17",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921007",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Development & Behavioral Pediatrics of the Carolina's-Charlotte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; 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.