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Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Cardiovascular Surgery of Danville
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
201 S MAIN ST, SUITE 1100, DANVILLE, VA 24541-2927
(434) 791-3009
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07020
BCBS GRP
NC
01
—
1029437078
TRICARE GRP
—
05
—
7907025
—
NC
Enumeration date
07/09/2006
Last updated
07/11/2022
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