Provider Demographics
NPI:1497750939
Name:DURHAM INTERNAL MEDICINE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DURHAM INTERNAL MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:SINGLETARY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:919-477-6900
Mailing Address - Street 1:4205 BEN FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2143
Mailing Address - Country:US
Mailing Address - Phone:919-477-6900
Mailing Address - Fax:919-477-5081
Practice Address - Street 1:4205 BEN FRANKLIN BLVD
Practice Address - Street 2:DBA DURHAM INTERNAL MEDICINE ASSOCIATES
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2143
Practice Address - Country:US
Practice Address - Phone:919-477-6900
Practice Address - Fax:919-477-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902669Medicaid
NC230309Medicare PIN
NC8902669Medicaid