Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Durham OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
2609 N DUKE ST, SUITE 204, DURHAM, NC 27704-3048
(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
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07020
BCBS GRP
NC
05
—
5950788
—
NC
Enumeration date
07/15/2006
Last updated
07/11/2022
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