Healthcare Provider Details

I. General information

NPI: 1972824787
Provider Name (Legal Business Name): DARIN DUFAULT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL, MSC 333
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

40 DUKE MEDICINE CIR ROOM 202 MAIN HOSPITAL, MSC 333
DURHAM NC
27710-4000
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-1344
  • Fax:
Mailing address:
  • Phone: 919-684-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL32658
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2016-00551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: