PRIVATE DIAGNOSTIC CLINIC, PLLC

Provider Demographics

• NPI: 1457389033
• Name: PRIVATE DIAGNOSTIC CLINIC, PLLC
• Entity Type: Organization
• Organization Name: PRIVATE DIAGNOSTIC CLINIC, PLLC
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: CHRISTOPHER
• Authorized Official - Middle Name: THOMAS
• Authorized Official - Last Name: FREDERICK
• Authorized Official - Phone: 919-613-7762
• Mailing Address - Street 1: PO BOX 110566
• 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: 40 DUKE MEDICINE CIR
• Practice Address - City: DURHAM
• Practice Address - State: NC
• Practice Address - Zip Code: 27710-4000
• Practice Address - Country: US
• Practice Address - Phone: 919-684-8111
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-30
• Last Update Date: 2022-07-11

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	207K00000X	Allopathic & Osteopathic Physicians	Allergy & Immunology		Group - Multi-Specialty
No	207N00000X	Allopathic & Osteopathic Physicians	Dermatology		Group - Multi-Specialty
No	207P00000X	Allopathic & Osteopathic Physicians	Emergency Medicine		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	208800000X	Allopathic & Osteopathic Physicians	Urology		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	230574	Medicare PIN
NC	230586	Medicare PIN
NC	2310523C	Medicare PIN
NC	1405	Medicare PIN
NC	230580	Medicare PIN
NC	230584	Medicare PIN
NC	230570	Medicare PIN
NC	230576	Medicare PIN
NC	230575	Medicare PIN
NC	230581	Medicare PIN
NC	230583	Medicare PIN
NC	230587	Medicare PIN
VA	C08239	Medicare PIN
NC	230573	Medicare PIN
NC	230585	Medicare PIN
NC	230572	Medicare PIN
NC	230582	Medicare PIN
NC	230864	Medicare PIN
NC	2310523	Medicare PIN
NC	230577	Medicare PIN