Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
NorthEast Cardiovascular
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
200 MEDICAL PARK DR, SUITE 230, CONCORD, NC 28025-2982
(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
—
0227Y
BCBS GRP
NC
05
—
890227Y
—
NC
Enumeration date
07/09/2006
Last updated
07/11/2022
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