Healthcare Provider Details

I. General information

NPI: 1871971960
Provider Name (Legal Business Name): BRENDAN CHRISTOPHER CLINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27710-7005
US

IV. Provider business mailing address

BOX 3808 DUMC
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2711
  • Fax:
Mailing address:
  • Phone: 919-684-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2019-02020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: