MEDICARE: T CRAIG DERIAN MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	31269	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0127N	OTHER	NC	BCBS CORPORATE NUMBER
2	0217N	OTHER		BCBS CORPORATE NUMBER

General Provider Information

NPI Number	:	1528199379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T CRAIG DERIAN MD PLLC

Provider Business Mailing Address
First Line	:	4206 N ROXBORO STREET
Second Line	:	SUITE 120
City	:	DURHAM
State	:	NC
Zip	:	27704-1868
Country	:	US
Telephone Number	:	919-479-4160
Fax Number	:	919-479-4116

Provider Business Practice Location Address
First Line	:	4206 N ROXBORO STREET
Second Line	:	SUITE 120
City	:	DURHAM
State	:	NC
Zip	:	27704-1868
Country	:	US
Telephone Number	:	919-479-4160
Fax Number	:	919-479-4116

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS CRAIG DERIAN
Credential	:	MD
Telephone Number	:	919-479-4160

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/30/2009

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