=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942685458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURANT ROAD PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2015
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10940 RAVEN RIDGE RD STE 200
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27614-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-205-4410
-----------------------------------------------------
Fax | 984-200-2821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10940 RAVEN RIDGE RD STE 200
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27614-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-205-4410
-----------------------------------------------------
Fax | 984-200-2821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | PRIYANKA ARORA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 919-205-4410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2013-01360
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------