Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
North Carolina Orthopaedic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
3609 SW DURHAM DR, DURHAM, NC 27707-6507
(919) 471-9622
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
Primary
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07020
BCBS GRP
NC
05
—
7907025
—
NC
Enumeration date
07/09/2006
Last updated
07/11/2022
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