Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2010-04-22
- Last updated
- 2025-06-26
Specialties
Licenses
- License TN
- 0000048406
Location
- Practice location
- 2301 ERWIN RD
- City
- DURHAM NC
- Postal code
- 277054699
- Phone
- 517-403-6418
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.