=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356677611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER JOSEPH DUQUETTE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2009
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MANNING DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-966-4845
-----------------------------------------------------
Fax | 919-966-2230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UNIVERSITY OF NORTH CAROLINA CAMPUS BOX 7255
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27599-7255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-966-4845
-----------------------------------------------------
Fax | 919-966-2230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 3865
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3865
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------