Healthcare Provider Details

I. General information

NPI: 1043630502
Provider Name (Legal Business Name): KONRAD MICHAEL DZIAMSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E NC HIGHWAY 54 STE 200
DURHAM NC
27713-5271
US

IV. Provider business mailing address

2222 E NC HIGHWAY 54 STE 200
DURHAM NC
27713-5271
US

V. Phone/Fax

Practice location:
  • Phone: 919-405-2040
  • Fax: 919-747-4195
Mailing address:
  • Phone: 919-405-2040
  • Fax: 919-747-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101275460
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberTP276
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101275460
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2023-03036
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD466766
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: