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General NPI Number Information
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NPI Number | 1295990323
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Entity Type | Organization
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Legal Business Name | PRIVATE DIAGNOSTIC CLINIC, PLLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 05/15/2022
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Provider Practice Location Address
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Address Line | 566 RUIN CREEK RD
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City | HENDERSON
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State | NC
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Zip | 27536-2927
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Country | US
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Telephone | 252-436-1880
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Fax | 252-436-1149
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Provider Business Mailing Address
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Address Line | PO BOX 110566
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City | DURHAM
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State | NC
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Zip | 27709-5566
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Country | US
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Telephone | 919-620-4855
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Fax | 919-620-4921
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Authorized Official
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Title or Position | CFO
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Name | CHRISTOPHER THOMAS FREDERICK
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Credential |
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Telephone | 919-613-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | NC
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