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9625 Northcross Center Ct Suite 102-b Huntersville NC 28078-7348 | |
| (704) 801-1240 | |
| (704) 801-1241 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology |
| Location | 9625 Northcross Center Ct, Huntersville, North Carolina |
| Authorized Official Name and Position | Frieda M Lowder (VP) |
| Authorized Official Contact | 7044034146 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9625 Northcross Center Ct Suite 102-b Huntersville NC 28078-7348 Ph: (704) 801-1240 | 9625 Northcross Center Ct Suite 102-b Huntersville NC 28078-7348 Ph: (704) 801-1240 |
| NPI Number | 1457557795 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457557795 | NPI | - | NPPES |
| 5906850 | Medicaid | NC | |
| NPB455 | Medicaid | SC | |
| DF8926 | Other | NC | RAILROAD MEDICARE PTAN |
| 015Y1 | Other | NC | BCBS |
| 019FG | Other | NC | BCBS EFF 7-1-07 |
| 5914183 | Medicaid | NC | |
| 355573 | Other | NC | MAMSI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | (* (Not Available)) | Primary |
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