Healthcare Provider Details

I. General information

NPI: 1063591378
Provider Name (Legal Business Name): DURHAM AREACORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 BROAD ST
DURHAM NC
27704-3009
US

IV. Provider business mailing address

2611 BROAD ST
DURHAM NC
27704-3009
US

V. Phone/Fax

Practice location:
  • Phone: 919-358-7296
  • Fax: 919-287-2869
Mailing address:
  • Phone: 919-358-7296
  • Fax: 919-287-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANITA VASS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 919-358-7296