Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Cardiovascular Surgery of Danville
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
201 S MAIN ST, SUITE 1100, DANVILLE, VA 24541-2927
(434) 791-3009
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07020
BCBS GRP
NC
01
—
1029437078
TRICARE GRP
—
05
—
7907025
—
NC
Enumeration date
07/09/2006
Last updated
07/11/2022
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