Provider Demographics
NPI:1528199379
Name:T CRAIG DERIAN MD PLLC
Entity Type:Organization
Organization Name:T CRAIG DERIAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-479-4160
Mailing Address - Street 1:4206 N ROXBORO STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1868
Mailing Address - Country:US
Mailing Address - Phone:919-479-4160
Mailing Address - Fax:919-479-4116
Practice Address - Street 1:4206 N ROXBORO STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1868
Practice Address - Country:US
Practice Address - Phone:919-479-4160
Practice Address - Fax:919-479-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0127NOtherBCBS CORPORATE NUMBER
0217NOtherBCBS CORPORATE NUMBER
2344479Medicare UPIN
0217NOtherBCBS CORPORATE NUMBER