PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1871519371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871519371 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DURHAM PATHOLOGY ASSOCIATES / DURHAM REGIONAL HOSPITAL |
| Practice Address |
3643 N Roxboro St Durham NC 27704-2702 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9196848111 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2011-12-08 |
| Authorized Official Name | MR. MARK L CANTRELL (CHIEF PRIVACY & COMPLIANCE OFFICER) |
| Authorized Official Telephone | 9196685161 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS GRP | 0282U | 01 |
| NC | 890282U | 05 |
| Other Name | Type Code |
|---|---|
| Durham Pathology Associates / Durham Regional Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538616289 | Private Diagnostic Clinic, Pllc | Neurological Surgery | 1212 Cedarhurst Dr Ste 102, Raleigh, NC 27609-5588 | 2016-09-09 |
| 1083168181 | Private Diagnostic Clinic, Pllc | Internal Medicine | 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 | 2016-08-08 |
| 1124459292 | Private Diagnostic Clinic, Pllc | Occupational Therapist | Duke Clinic 1e, 40 Duke Medicine Circle, Durham, NC 27710-0001 | 2013-11-27 |
| 1609116664 | Private Diagnostic Clinic, Pllc | Dermatology | 82 Wheaton Ave, Youngsville, NC 27596-8691 | 2013-02-27 |
| 1487903423 | Private Diagnostic Clinic, Pllc | Pediatrics | 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 | 2012-09-06 |
| 1558639864 | Private Diagnostic Clinic, Pllc | Allergy & Immunology | 30 Duke Medicine Circle, Durham, NC 27710-3000 | 2011-12-01 |
| 1972826568 | Private Diagnostic Clinic, Pllc | Family Medicine | 800 Clayton Rd, Durham, NC 27703-2606 | 2010-03-10 |
| 1891021853 | Private Diagnostic Clinic, Pllc | Obstetrics & Gynecology | 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 | 2009-10-27 |
| 1447480413 | Private Diagnostic Clinic, Pllc | Orthopaedic Surgery | 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 | 2009-07-23 |
| 1841446762 | Private Diagnostic Clinic, Pllc | Otolaryngology | 783 Doctors Ct Ste C, Roxboro, NC 27573-4575 | 2008-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRIVATE DIAGNOSTIC CLINIC, PLLC | Duke University Medical Center, Durham, NC 27710-0001 |
| Street Address |
3643 N ROXBORO ST |
| City | DURHAM |
| State | NC |
| Zip Code | 27704-2702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033113899 | Nirmish Shah | Internal Medicine | 3643 N Roxboro St, Durham, NC 27704-2702 | 2005-06-09 |
| 1548872633 | Christopher James Rogge | Nurse Anesthetist, Certified Registered | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-08-19 |
| 1801404579 | Grace L Johnson | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-07-20 |
| 1174147102 | Kaitlyn Elizabeth Cockerham | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-06-05 |
| 1306466859 | Keri Laurelle Konstant | Registered Nurse | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-04-24 |
| 1194351262 | Deidre Pelletier | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-03-20 |
| 1720618812 | Elizabeth Parker Sulentic | Nurse Practitioner | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-01-17 |
| 1265079131 | Melinda Yvonne House | Nurse Practitioner | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-12-10 |
| 1427607811 | Grace Amy Revenaugh Dreyer | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-09-09 |
| 1841848934 | Ann Mei Lin | Hospitalist | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-08-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245723139 | Devang Ashokbhai Patel | Dentist | 2609 N Duke St Ste 618, Durham, NC 27704 | 2018-06-14 |
| 1891201042 | Little Family Care Home, LLC | Custodial Care Facility | 1012 Davinci Street, Durham, NC 27704 | 2017-12-26 |
| 1033625702 | Tondra A Little | Social Worker | 2804 Nellowood Street, Durham, NC 27704 | 2017-12-18 |
| 1437502408 | Jhazmere Shamas Preston | Counselor | 2609 N. Duke St. Suite 403, Durham, NC 27704 | 2016-07-14 |
| 1649626656 | Professional Elevations Pllc | Case Manager/Care Coordinator | 304 Crutchfield Drive, Durham, NC 27704 | 2016-05-09 |
| 1083071617 | Alyssa Wilson | Speech-Language Pathologist | 215 William Penn Plz Apt 908, Durham, NC 27704 | 2016-01-27 |
| 1932565124 | Arthur Reynolds Jr and Associates P.l.l.c. | Dentist | 2106 N Duke St, Durham, NC 27704 | 2016-01-05 |
| 1962877720 | Chimere Brooks | Contractor | 4001meriwether Drive Apt P-19, Durham, NC 27704 | 2015-12-04 |
| 1184013294 | Danielle King | Physician Assistant | 3611 N Duke Street, Durham, NC 27704 | 2015-01-13 |
| 1730581901 | Images, 'of Me To You' | Community/Behavioral Health | 2823 Cascadilla Street, Durham, NC 27704 | 2014-09-19 |
| Find all providers in zip 27704 | ||||
| Taxonomy Code | 207ZP0105X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Clinical Pathology/Laboratory Medicine |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831285063 | Maureen S Bauer | Pathology | 1000 Trent Dr, Durham, NC 27710-0001 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457403206 | James Russell Devillier | Pathology | 296 Denada Path, Roxboro, NC 27574-6306 | 2007-01-18 |
| 1588633911 | Anthony Alfredo Corsini | Pathology | Naval Hospital Camp Lejeune, Lab Dept. 51, 100 Brewster Blvd., Camp Lejeune, NC 28547-2538 | 2006-03-17 |
| 1659926749 | Manuel Torres | Pathology | 509 Biltmore Ave, Asheville, NC 28801-4601 | 2019-08-06 |
| 1073891719 | Caromont Medical Group Inc | Pathology | 2240 Remount Rd, Ste 300, Gastonia, NC 28054-4725 | 2011-07-29 |
| 1942481247 | Kemery Linay Gilbert | Pathology | 201 E Grover St, Shelby, NC 28150-3917 | 2007-11-15 |
| 1982808929 | Eagle Physicians and Associates Pa | Pathology | 301 E Wendover Ave, Suite 300, Greensboro, NC 27401-1230 | 2007-06-13 |
| 1003022468 | Jennifer Egan | Pathology | 101 Manning Dr, Rm 1107g W Wing, Chapel Hill, NC 27514-4220 | 2007-05-15 |
| 1659584837 | Alicia Carter | Pathology | 101 Manning Dr, Rm 1107g W Wing, Chapel Hill, NC 27514-4220 | 2007-05-07 |
| 1497968606 | Ruth Fulghum Walters | Pathology | 2238 Nelson Hwy, Suite 100, Chapel Hill, NC 27517-8914 | 2007-05-07 |
| 1942413083 | Stephanie P Mathews | Pathology | 143 W Franklin St, Suite 600, Chapel Hill, NC 27516-2539 | 2007-05-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.