PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1417295940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417295940 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DUKE PEDIATRIC DERMATOLOGY @ PATTERSON PLACE |
| Practice Address |
5324 Mcfarland Rd Ste. 410 Durham NC 27707-6865 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9196848111 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |
| Authorized Official Name | PAUL RAYMOND NEWMAN (EXECUTIVE DIRECTOR, PDC) |
| Authorized Official Telephone | 9196137652 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Duke Pediatric Dermatology @ Patterson Place | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538616289 | Private Diagnostic Clinic, Pllc | Neurological Surgery | 1212 Cedarhurst Dr Ste 102, Raleigh, NC 27609-5588 | 2016-09-09 |
| 1083168181 | Private Diagnostic Clinic, Pllc | Internal Medicine | 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 | 2016-08-08 |
| 1124459292 | Private Diagnostic Clinic, Pllc | Occupational Therapist | Duke Clinic 1e, 40 Duke Medicine Circle, Durham, NC 27710-0001 | 2013-11-27 |
| 1609116664 | Private Diagnostic Clinic, Pllc | Dermatology | 82 Wheaton Ave, Youngsville, NC 27596-8691 | 2013-02-27 |
| 1487903423 | Private Diagnostic Clinic, Pllc | Pediatrics | 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 | 2012-09-06 |
| 1558639864 | Private Diagnostic Clinic, Pllc | Allergy & Immunology | 30 Duke Medicine Circle, Durham, NC 27710-3000 | 2011-12-01 |
| 1972826568 | Private Diagnostic Clinic, Pllc | Family Medicine | 800 Clayton Rd, Durham, NC 27703-2606 | 2010-03-10 |
| 1891021853 | Private Diagnostic Clinic, Pllc | Obstetrics & Gynecology | 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 | 2009-10-27 |
| 1447480413 | Private Diagnostic Clinic, Pllc | Orthopaedic Surgery | 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 | 2009-07-23 |
| 1841446762 | Private Diagnostic Clinic, Pllc | Otolaryngology | 783 Doctors Ct Ste C, Roxboro, NC 27573-4575 | 2008-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRIVATE DIAGNOSTIC CLINIC, PLLC | Duke University Medical Center, Durham, NC 27710-0001 |
| Street Address |
5324 MCFARLAND RD STE. 410 |
| City | DURHAM |
| State | NC |
| Zip Code | 27707-6865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174562102 | Diana Borton Mcshane | Dermatology | 5324 Mcfarland Rd, Suite 410, Durham, NC 27707-6865 | 2006-06-05 |
| 1316392764 | Amanda Birkhead | Dietitian, Registered | 5324 Mcfarland Rd, Ste 150, Durham, NC 27707-6865 | 2016-05-03 |
| 1679927255 | Gregory Schiltz | Dietitian, Registered | 5324 Mcfarland Rd, Durham, NC 27707-6865 | 2016-04-20 |
| 1871973396 | Durham Lifestyle Management LLC | Dietitian, Registered | 5324 Mcfarland Rd, Ste 150, Durham, NC 27707-6865 | 2015-06-01 |
| 1942695200 | Ashton Jackson | Dietitian, Registered | 5324 Mcfarland Rd, Suite 150, Durham, NC 27707-6865 | 2015-04-03 |
| 1811385875 | Sarah Ray Healy | Dietitian, Registered | 5324 Mcfarland Rd, #150, Durham, NC 27707-6865 | 2014-12-29 |
| 1568887487 | Jessica R Iselin | Dietitian, Registered | 5324 Mcfarland Rd, Suite 150, Durham, NC 27707-6865 | 2014-02-28 |
| 1134540768 | Deborah Franciscy | Dietitian, Registered | 5324 Mcfarland Rd, Suite 150, Durham, NC 27707-6865 | 2013-12-27 |
| 1831520188 | Tyrone Hall | Dietitian, Registered | 5324 Mcfarland Rd, Suite 150, Durham, NC 27707-6865 | 2013-12-11 |
| 1548691975 | Ashley Karshen | Dietitian, Registered | 5324 Mcfarland Rd, Durham, NC 27707-6865 | 2013-12-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785928 | Ceara Smith | Social Worker | 1415 W Nc 54 Buidling 200, Suite 111, Durham, NC 27707 | 2020-06-22 |
| 1114554094 | Lauren Michelle Grosse | Physician Assistant | Fastmed Urgent Care 7010 Nc-751, Durham, NC 27707 | 2020-03-23 |
| 1386289635 | Ashley Bailey | Counselor | 1801 Fayetteville Street, Durham, NC 27707 | 2019-11-11 |
| 1881249886 | Erin Ramona Leger | Physical Therapist | 3706 Mayfair St, Ste 120, Durham, NC 27707 | 2019-08-06 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1477026144 | Pope Behavioral Health and Wellness | Counselor | 5102 Chapel Hill Durham Blvd., Suite 101, Durham, NC 27707 | 2019-01-06 |
| 1043780778 | Jessica Ann Revels | Counselor | 1415 West North Carolina 54, Building 100 Suite # 204, Durham, NC 27707 | 2018-11-26 |
| 1558830125 | Michael Brown | Counselor | 1502 W Nc-54, Suite 505, Durham, NC 27707 | 2018-11-13 |
| 1780152827 | Cassandra Gerwig Shaw | Registered Nurse | 5324 Mcfarland Dr Ste 310, Durham, NC 27707 | 2018-11-07 |
| 1942776232 | Lisa J Keskitalo | Physical Therapist | 3708 Mayfair St Ste 120, Durham, NC 27707 | 2018-10-15 |
| Find all providers in zip 27707 | ||||
| Taxonomy Code | 207NP0225X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Pediatric Dermatology |
| A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: changed definition, added source] Additional Resources: American Board of Dermatology, 2007, http://www.abderm.org/ A subspecialty certificate was approved by ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073155032 | Burkhart Pediatric & Adolescent Dermatology Pllc | Dermatology | 135 Parkway Office Ct Ste 201, Cary, NC 27518-7425 | 2019-10-11 |
| 1558452532 | Kathleen F Russo | Dermatology | 129 Woodson St, Salisbury, NC 28144-3255 | 2006-09-27 |
Please comment or provide details below to improve the information on PRIVATE DIAGNOSTIC CLINIC, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.