Provider Demographics
NPI:1467457184
Name:DUFF, DENISE ELAINE
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ELAINE
Last Name:DUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5823
Mailing Address - Country:US
Mailing Address - Phone:704-334-7800
Mailing Address - Fax:704-334-7818
Practice Address - Street 1:1701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5823
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:704-334-7818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC397922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929292Medicaid
NC8929292Medicaid
NC2162069Medicare ID - Type Unspecified