Healthcare Provider Details

I. General information

NPI: 1336426287
Provider Name (Legal Business Name): EMERGEORTHO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

IV. Provider business mailing address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-5255
  • Fax: 919-313-1276
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-313-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number39442
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number39442
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39442
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number39442
License Number StateNC

VIII. Authorized Official

Name: THOMAS A. DIMMIG
Title or Position: PRESIDENT, TRIANGLE ORTHOPAEDIC
Credential: MD
Phone: 919-220-5255