Provider Demographics
NPI:1396785994
Name:DETERDING, JAMES LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEROY
Last Name:DETERDING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4159
Practice Address - Country:US
Practice Address - Phone:919-718-9512
Practice Address - Fax:919-718-9516
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26650207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-1274347OtherTAX ID # CAROLINA KIDNEY
NC28365OtherBCBS PROVIDER #
NC2491OtherPARTNERS PROV. #
NC390004557OtherRRM PROVIDER #
NC3100127OtherUHC PROVIDER #
NC8928365Medicaid