Provider Demographics
NPI:1932375102
Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Entity Type:Organization
Organization Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Other - Org Name:DUKE PRIMARY CARE PICKETT ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISIONAL COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-668-6008
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:919-620-4921
Practice Address - Street 1:3024 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6006
Practice Address - Country:US
Practice Address - Phone:919-490-9800
Practice Address - Fax:919-419-5842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2317755VMedicare PIN