NPIMap

Organization Active NPI

Private Diagnostic Clinic, PLLC

Doing business as Duke Cardiology Pembroke

  • Cardiovascular Disease Physician
  • Pembroke, NC
National Provider Identifier
1073860045
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PRIVATE DIAGNOSTIC CLINIC, PLLC
Doing business as
Duke Cardiology Pembroke
Practice address
812 Candy Park Rd
Pembroke, NC 28372-9129
Phone
(910) 671-6619
NPI assigned
Aug 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Authorized official

Name
Valla Fabrae Wilson
Title
Chief Compliance, Privacy & Audit
Phone
(919) 668-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

812 Candy Park Rd
Pembroke, NC 28372-9129

Mailing address

PO Box 110566
Durham, NC 27709-5566
Phone (919) 620-4855

Other names 1

  • Duke Cardiology Pembroke Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cabarrus Memorial Hospi23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1073860045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110566",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095566",
            "telephone_number": "919-620-4855",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 CANDY PARK RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283729129",
            "telephone_number": "910-671-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-09",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "VALLA",
        "authorized_official_middle_name": "FABRAE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE, PRIVACY & AUDIT",
        "authorized_official_telephone_number": "919-668-5161"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duke Cardiology Pembroke",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Duke Cardiology Pembroke",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.