Healthcare Provider Details

I. General information

NPI: 1891754636
Provider Name (Legal Business Name): DURHAM VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

1202 TRAILS END RD
DURHAM NC
27712-9142
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-416-5831
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-416-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number32908
License Number StateNC

VIII. Authorized Official

Name: DR. JONATHAN J WEINER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 919-286-0411