Provider Demographics
NPI:1790984375
Name:DEFREITAS, DORIAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:JOSEPH
Last Name:DEFREITAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 505
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7521
Mailing Address - Country:US
Mailing Address - Phone:919-306-8172
Mailing Address - Fax:
Practice Address - Street 1:4414 LAKE BOONE TRL STE 505
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7521
Practice Address - Country:US
Practice Address - Phone:919-784-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00565174400000X
NC2012-00656208600000X, 2086S0129X, 2086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920788Medicaid
NC5920788Medicaid