Active NPI
Marilyn J. Vedder, PH.D.
- Psychologist
- Durham, NC
National Provider Identifier
1639249501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1341
- Practice address
- 3001 Academy Rd Ste 240
Durham, NC 27707-2653 - Phone
- (919) 493-3457
- Fax
- (919) 493-2290
- NPI assigned
- Nov 8, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1341 | NC | Primary |
Addresses
Primary practice location
3001 Academy Rd Ste 240
Durham, NC 27707-2653
Mailing address
3001 Academy Rd Ste 240
Durham, NC 27707-2653
Phone (919) 493-3457
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1341 | Other | NC | STATE LICENSURE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 7, 2013 through Oct 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1341 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639249501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 ACADEMY RD STE 240",
"city": "DURHAM",
"state": "NC",
"postal_code": "277072653",
"telephone_number": "919-493-3457",
"fax_number": "919-493-2290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 ACADEMY RD STE 240",
"city": "DURHAM",
"state": "NC",
"postal_code": "277072653",
"telephone_number": "919-493-3457",
"fax_number": "919-493-2290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VEDDER",
"first_name": "MARILYN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1341",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE NUMBER",
"identifier": "1341",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
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- Sahaana Raghunathan Veeravalli, PHARMD
- Yovania Veeren Dechtiar
- Eleanor Anne Vega, MD
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.