Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Specialty Clinic Person Memorial
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
615 RIDGE RD, ROXBORO, NC 27573-4629
(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
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02149
BCBS
NC
05
—
8902149
—
NC
Enumeration date
07/15/2006
Last updated
07/11/2022
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