Healthcare Provider Details

I. General information

NPI: 1114423704
Provider Name (Legal Business Name): MICHELLE PONDER MD, DABOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DUKE MEDICINE CIRCLE CLINIC 1A
DURHAM NC
27710
US

IV. Provider business mailing address

40 DUKE MEDICINE CIRCLE CLINIC 1A
DURHAM NC
27710
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-3600
  • Fax:
Mailing address:
  • Phone: 919-684-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number301847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: