NPIMap

Organization Active NPI

Private Diagnostic Clinic, PLLC

  • Pediatrics Physician
  • Durham, NC
National Provider Identifier
1447306113
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PRIVATE DIAGNOSTIC CLINIC, PLLC
Practice address
4020 N Roxboro St
Durham, NC 27704-2120
Phone
(919) 684-8111
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Paul R. Newman
Title
Executive Director
Phone
(919) 620-4855

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X NC
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

4020 N Roxboro St
Durham, NC 27704-2120

Mailing address

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

Other names 1

  • Pediatric Primary Care Clinic Other name

National Provider Directory

National Provider Directory

Locations

4020 N Roxboro St
Durham, NC 27704
Phone (919) 490-9888

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1447306113",
    "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": "4020 N ROXBORO ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042120",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-620-4855"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Primary Care Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pediatric Primary Care Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.