Healthcare Provider Details

I. General information

NPI: 1114252343
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

3016 COURTNEY CREEK BLVD
DURHAM NC
27713-1510
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-6941
  • Fax:
Mailing address:
  • Phone: 919-599-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5995
License Number StateNC

VIII. Authorized Official

Name: MS. JESSICA BRIANNE AITKEN
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 919-286-6941