PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1720493521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720493521 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DURHAM GASTROENTEROLOGY CONSULTANTS |
| Practice Address |
249 E Nc Highway 54 Suite 200 Durham NC 27713-7512 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9198068322 |
| Practice Fax Number | 9194330409 |
| Mailing Telephone | 9198068322 |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2014-07-01 |
| Authorized Official Name | CHRISTOPHER T FREDERICK (CFO) |
| Authorized Official Telephone | 9196205042 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Durham Gastroenterology Consultants | 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 |
249 E NC HIGHWAY 54 SUITE 200 |
| City | DURHAM |
| State | NC |
| Zip Code | 27713-7512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891755153 | Scott Robert Brazer | Internal Medicine | 249 E Nc Highway 54, Suite 200, Durham, NC 27713-7512 | 2006-03-23 |
| 1275176059 | Crystal Danielle Cruz | Social Worker | 249 E Nc Highway 54, Durham, NC 27713-7512 | 2019-10-23 |
| 1386156511 | Zena Chase | Counselor | 249 E Nc Highway 54, Durham, NC 27713-7512 | 2017-10-27 |
| 1689029605 | B & D Integrated Health Services | Psychiatry & Neurology | 249 E Nc Highway 54, Suite 320, Durham, NC 27713-7512 | 2016-04-27 |
| 1235593989 | Emergeortho, Pa | Durable Medical Equipment & Medical Supplies | 249 E Nc Highway 54, Durham, NC 27713-7512 | 2016-04-08 |
| 1295196780 | Lld Laboratories, LLC | Clinic/Center | 249 E Nc Highway 54, Suite 310, Durham, NC 27713-7512 | 2016-03-11 |
| 1770942005 | Carolina Women S Research and Wellness Center | Obstetrics & Gynecology | 249 E Nc Highway 54, Suite 330, Durham, NC 27713-7512 | 2016-02-15 |
| 1831565027 | Shama Lau-rel Frazer | Social Worker | 249 E Nc Highway 54, Suite 320, Durham, NC 27713-7512 | 2015-08-11 |
| 1316322233 | Martha Mangum Holland | Dentist | 249 E Nc Highway 54, Durham, NC 27713-7512 | 2015-07-21 |
| 1851780399 | Daniel George Merke | Physical Therapist | 249 E Nc Highway 54, Durham, NC 27713-7512 | 2015-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558977074 | Zoe Wellness | Clinic/Center | 5322 Nc 55, 102, Durham, NC 27713 | 2020-09-21 |
| 1194352542 | Mariah Davis | Counselor | 1822 East Hwy Nc 54, Suite 300, Durham, NC 27713 | 2020-03-25 |
| 1316589138 | Monarch | Community/Behavioral Health | 1513 Piperwood Court, Durham, NC 27713 | 2019-10-14 |
| 1205486081 | Lisa Mesmer Barnes | Nurse Practitioner | 5309hwy 55, Suite 105, Durham, NC 27713 | 2019-09-13 |
| 1497315352 | Mary Therese Wood | Social Worker | 1822 E Highway 54, Suite 300, Durham, NC 27713 | 2019-06-13 |
| 1720558307 | Kevin D Simmons | Counselor | 1822 Nc Hwy 54 Suite 300, Durham, NC 27713 | 2018-11-27 |
| 1790265585 | Kelli Cryer | Counselor | 54 E Nc Hwy 1822, Suite 300, Durham, NC 27713 | 2018-08-21 |
| 1477039253 | Mahavir Rx, LLC | Pharmacy | 6216 Fayetteville Rd Ste 105, Durham, NC 27713 | 2018-07-16 |
| 1811482862 | Tessa Taylor | Dentist | 2515 E Nc Highway 54 Ste 2000, Durham, NC 27713 | 2018-06-22 |
| 1013401579 | Emily Louise Haller | Counselor | 1822 E Hwy 54, Suite 300, Durham, NC 27713 | 2018-06-19 |
| Find all providers in zip 27713 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235365297 | Matthew R Kappus | Internal Medicine | Duke Gastroenterology Dumc 3923, Durham, NC 27710 | 2009-06-04 |
| 1962571232 | Douglas A. Drossman | Internal Medicine | 5826 Fayetteville Rd Ste 201, Durham, NC 27713-8684 | 2006-11-08 |
| 1780785196 | Dawn Provenzale | Internal Medicine | 508 Fulton St # 152, Building 6, Durham, NC 27705-3875 | 2006-09-26 |
| 1487602561 | Richard K Wood Jr. | Internal Medicine | Dumc 3662, Durham, NC 27710-0001 | 2006-05-04 |
| 1891755153 | Scott Robert Brazer | Internal Medicine | 249 E Nc Highway 54, Suite 200, Durham, NC 27713-7512 | 2006-03-23 |
| 1902875727 | John T Geneczko Jr. | Internal Medicine | 200 Trent Dr, 3662 Dumc, Durham, NC 27710-2479 | 2006-03-15 |
| 1013310457 | Raghubinder S Gill | Internal Medicine | 40 Duke Medicine Cir, Duke Clinic 2h, Durham, NC 27710-4000 | 2014-09-30 |
| 1730593013 | Danny George Cheriyan | Internal Medicine | 40 Duke Medicine Cir, Durham, NC 27710-4000 | 2014-06-16 |
| 1467794735 | Brian Sullivan | Internal Medicine | 508 Fulton St, Durham, NC 27705-3875 | 2013-03-25 |
| 1194083527 | Benjamin Rembold Lloyd | Internal Medicine | 2301 Erwin Rd, Durham, NC 27705-4699 | 2012-04-23 |
| Find all providers in DURHAM | ||||
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| 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.