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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