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General NPI Number Information
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NPI Number | 1417402462
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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 | 08/19/2016
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 5601 ARRINGDON PARK DR
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City | MORRISVILLE
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State | NC
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Zip | 27560-5676
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Country | US
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Telephone | 919-660-5066
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Fax |
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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 | PRACTICE CHIEF FINANCIAL OFFICER
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Name | MR. CHRISTOPHER T FREDERICK
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Credential |
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Telephone | 919-620-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | NC
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