Provider Demographics
NPI:1770224875
Name:PRIVATE DIAGNOSTIC CLINIC, PLLC
Entity type:Organization
Organization Name:PRIVATE DIAGNOSTIC CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-613-7762
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
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:
Practice Address - Street 1:100 DUKE HEALTH CARY PLACE
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:919-385-8120
Practice Address - Fax:919-385-9500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVATE DIAGNOSTIC CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty