Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Parent organization
PRIVATE DIAGNOSTIC CLINIC
Other names
Durham Regional Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIVATE DIAGNOSTIC CLINIC
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-4000
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NC
207RC0000X
Cardiovascular Disease Physician
—
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
NC
207RP1001X
Pulmonary Disease Physician
—
NC
207V00000X
Obstetrics & Gynecology Physician
—
NC
208600000X
Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
NC
367A00000X
Advanced Practice Midwife
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903564
—
NC
Enumeration date
07/30/2008
Last updated
07/11/2022
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