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PRIVATE DIAGNOSTIC CLINIC PLLC NPI 1124051214


NPI Information

NPI: 1124051214
Provider Name: PRIVATE DIAGNOSTIC CLINIC, PLLC

Doing Business As: DURHAM OB/GYN

Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 34D0241427

Address:
5726 FAYETTEVILLE RD
SUITE 101
DURHAM, NC
ZIP 27713
Phone: (919) 684-8111
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PRIVATE DIAGNOSTIC CLINIC, PLLC is an obstetrics gynecology in Durham, NC. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. PRIVATE DIAGNOSTIC CLINIC, PLLC NPI is 1124051214. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Durham Ob/gyn.

The provider's business location address is:

5726 FAYETTEVILLE RD
SUITE 101
DURHAM, NC
ZIP 27713-296
Phone: (919) 684-8111

The provider's authorized official is Christopher Thomas Frederick .
The authorized official title is Cfo and has the following contact phone number (919) 613-7762.

The CLIA number assigned to this NPI record is 34D0241427 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/9/2006 and was last updated on 5/13/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10126UOTHERNORTH CAROLINABCBS GRP
2790126UMEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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