Healthcare Provider Details

I. General information

NPI: 1790984375
Provider Name (Legal Business Name): DORIAN JOSEPH DEFREITAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 505
RALEIGH NC
27607-7521
US

IV. Provider business mailing address

4414 LAKE BOONE TRL STE 505
RALEIGH NC
27607-7521
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-2300
  • Fax:
Mailing address:
  • Phone: 919-306-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2012-00565
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2012-00656
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2012-00656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: