Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Urology of Raleigh
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
3404 WAKE FOREST RD, SUITE 302, RALEIGH, NC 27609-7340
(919) 684-8111
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07020
GRP
NC
05
—
7907025
—
NC
Enumeration date
07/09/2006
Last updated
05/15/2022
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