Darrin W Dereu, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0805 Issued in NC

Practice address

N Carolina State University
2500 Warren Carrol Drive, Box 8502
Raleigh, NC 27695-8502

Phone

(919) 513-7295

NPI assigned

Jul 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053326520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 SOSA RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104097",
            "telephone_number": "919-513-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N CAROLINA STATE UNIVERSITY",
            "address_2": "2500 WARREN CARROL DRIVE, BOX 8502",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276958502",
            "telephone_number": "919-513-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREU",
        "first_name": "DARRIN",
        "middle_name": "W",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "0805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.