Healthcare Provider Details

I. General information

NPI: 1710136791
Provider Name (Legal Business Name): DURHAM VAMC/DUKE UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSRB II 106 RESEARCH DR ROOM 2018,
DURHAM NC
27710-0001
US

IV. Provider business mailing address

MSRB II 106 RESEARCH DR ROOM 2018,
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-9984
  • Fax:
Mailing address:
  • Phone: 919-684-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MING YAN
Title or Position: RESEARCH ASSOCIATE, SR
Credential: MD
Phone: 919-684-9984