Provider Demographics
NPI:1962463125
Name:DERIAN, THOMAS CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CRAIG
Last Name:DERIAN
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 1:4206 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
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31269207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344479Medicare ID - Type Unspecified
C83517Medicare UPIN
NCC83517Medicare UPIN
2344479Medicare PIN