Healthcare Provider Details

I. General information

NPI: 1407028400
Provider Name (Legal Business Name): DURHAM VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

228 STANDISH DR
CHAPEL HILL NC
27517-5553
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number186904
License Number StateNC

VIII. Authorized Official

Name: MS. DARIA D. LEWIS
Title or Position: SICU STAFF NURSE
Credential: RN, BSN
Phone: 919-286-0411