1033621719 NPI number — DUKE UNIVERSITY

Table of content: (NPI 1033621719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033621719 NPI number — DUKE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUKE UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033621719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 WEST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 400A
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-286-3232
Provider Business Mailing Address Fax Number:
919-286-1021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4825 CREEKSTONE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-941-0407
Provider Business Practice Location Address Fax Number:
919-941-9173
Provider Enumeration Date:
11/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
DUKE UNIV. SOP EXEC. VICE DEAN FOR
Authorized Official Telephone Number:
919-684-3945

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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