Healthcare Provider Details

I. General information

NPI: 1912089020
Provider Name (Legal Business Name): DAVID S PISETSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 N ROXBORO ST
DURHAM NC
27704-2121
US

IV. Provider business mailing address

4101 N ROXBORO ST
DURHAM NC
27704-2121
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax:
Mailing address:
  • Phone: 919-684-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number22806
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number22806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: