Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Cardiology of Sanford
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CHIEF FINANCIAL OFFICER)
(919) 613-7762
Entity
Organization
Contact information
Practice address
1309 CARTHAGE ST, SANFORD, NC 27330-8984
(919) 774-6262
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0268Y
GRP
NC
01
—
1029437023
TRICARE GRP
—
05
—
790268Y
—
NC
Enumeration date
07/09/2006
Last updated
05/13/2022
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