Provider Demographics
NPI:1659418515
Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC
Entity Type:Organization
Organization Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC
Other - Org Name:DUKE PRIMARY CARE TIMBERLYNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISIONAL COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-416-8100
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-5566
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:77 VILCOM CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1598
Practice Address - Country:US
Practice Address - Phone:919-942-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906039Medicaid
NC2317755PMedicare PIN
NC5906039Medicaid
NC2317755HMedicare PIN
NCCN4481Medicare PIN
NCCG3138Medicare PIN