PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1952692303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952692303 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DUKE CHILDREN'S CARDIOLOGY OF CHARLOTTE |
| Practice Address |
1718 E 4th St Suite 304 Charlotte NC 28204-3261 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 7043161220 |
| Practice Fax Number | 7043161230 |
| Mailing Telephone | 9196204700 |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |
| Authorized Official Name | JOHN P. DION (CFO-PDC) |
| Authorized Official Telephone | 9196137762 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Duke Children's Cardiology of Charlotte | 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 |
1718 E 4TH ST SUITE 304 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28204-3261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841298239 | Kevin Hsu | Internal Medicine | 1718 E 4th St, Ste 501, Charlotte, NC 28204-3260 | 2005-07-11 |
| 1205373081 | Miranda L Williams | Physician Assistant | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2017-01-31 |
| 1881138873 | Shannon Scandone | Nurse Practitioner | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2016-12-09 |
| 1063963866 | Jessica Puskarich | Nurse Practitioner | 1718 E 4th St, Suite 307, Charlotte, NC 28204-3261 | 2016-10-18 |
| 1801343793 | Novant Medical Group, Inc | Pediatrics | 1718 E 4th St, Suite 601, Charlotte, NC 28204-3261 | 2016-09-08 |
| 1497107536 | Kelly J Coleman | Nurse Practitioner | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2016-07-12 |
| 1447616602 | Lindsay Spears Taylor | Physician Assistant | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2016-01-04 |
| 1982089322 | Melanie Moshier | Genetic Counselor, MS | 1718 E 4th St, Suite 608, Charlotte, NC 28204-3261 | 2015-07-28 |
| 1962886218 | Novant Medical Group, Inc | Pediatrics | 1718 E 4th St, Suite 401, Charlotte, NC 28204-3261 | 2015-07-16 |
| 1780071373 | Shannon Deluca | Nurse Practitioner | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2015-04-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285263582 | Precise Home Care Service LLC | In Home Supportive Care | 1935 Baxter Street, Unit 101, Charlotte, NC 28204 | 2020-04-07 |
| 1285276253 | Shannon Miller | Counselor | 1432 E Seventh Street, Charlotte, NC 28204 | 2019-10-11 |
| 1194282202 | Madison Joann Mcgarrigle | Behavior Technician | 1401 East 7th Street, Charlotte, NC 28204 | 2019-02-25 |
| 1255802674 | Stacey D. Alston, Dds, Pa | Dentist | 1020 E. 10th St., Suite 1, Charlotte, NC 28204 | 2018-12-11 |
| 1972082097 | Kim Webb Talbert | Nurse Practitioner | Novant Health Presbyterian Medical Center Charlotte, 200 Hawthorne Lane, Charlotte, NC 28204 | 2018-08-09 |
| 1164910535 | Jesse Elijah Roberts | Counselor | 1801 E 5th Street, #208, Charlotte, NC 28204 | 2018-05-01 |
| 1336696848 | Eight Healthcare | Exclusive Provider Organization | 2455 Weddington Ave, 2110, Charlotte, NC 28204 | 2016-09-01 |
| 1225480551 | Kathleen Quintana Bradley | Physician Assistant | 1523 Elizabeth Ave., Suite 200, Charlotte, NC 28204 | 2016-07-11 |
| 1184049777 | Della Franklin | Speech-Language Pathologist | 1021 Morehead Medical Dr Ste 3300, Charlotte, NC 28204 | 2014-02-19 |
| 1225459845 | Healing Arts Medical, Pa | Family Medicine | 335 N. Caswell Rd., Charlotte, NC 28204 | 2013-12-27 |
| Find all providers in zip 28204 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952626376 | Carolinas Physicians Network, Inc. | Pediatrics | 14214 Ballantyne Lake Road, Suite 150, Charlotte, NC 28277-3373 | 2010-03-29 |
| 1114152469 | Frances Chen Travelli | Pediatrics | 1718 E 4th St Ste 605, Charlotte, NC 28204-3282 | 2009-05-15 |
| 1861978785 | Novant Medical Group, Inc. | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8246 | 2018-07-13 |
| 1306117346 | Jennifer Bailey | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2012-01-23 |
| 1730409046 | Aaron Prosnitz | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2010-06-09 |
| 1881919306 | Carolinas Physicians Network, Inc. | Pediatrics | 1000 Blythe Blvd Fl 4, Charlotte, NC 28203-5812 | 2010-03-29 |
| 1639339450 | Matthew Brothers | Pediatrics | 1718 E 4th St, Suite 605, Charlotte, NC 28204-3261 | 2008-06-16 |
| 1417179078 | Gonzalo Wallis | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2007-05-03 |
| 1811068281 | James Herlong | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2006-11-10 |
| 1659382059 | William Wallace Hammill | Pediatrics | 1718 E 4th St, Suite 401, Charlotte, NC 28204-3261 | 2006-08-10 |
| Find all providers in CHARLOTTE | ||||
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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.