Provider Demographics
NPI:1518311844
Name:VERDE, AUDREY ROSE (MD, PHD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROSE
Last Name:VERDE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ROSE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN ROAD DUMC 3808
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4617
Practice Address - Country:US
Practice Address - Phone:919-684-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-005202085R0202X
NC2179582085R0202X
TN655202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology