Provider Demographics
NPI:1629269873
Name:DUKE UNIVERSITY
Entity Type:Organization
Organization Name:DUKE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REF FELLOW PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAVRILOVA-JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-807-2953
Mailing Address - Street 1:5438 ECHO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6949
Mailing Address - Country:US
Mailing Address - Phone:619-807-2953
Mailing Address - Fax:
Practice Address - Street 1:5704 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9089
Practice Address - Country:US
Practice Address - Phone:619-807-2953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty