1205809787 NPI number — DR. CHRISTIAN E MAGURA M.D.

Table of content: DR. CHRISTIAN E MAGURA M.D. (NPI 1205809787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205809787 NPI number — DR. CHRISTIAN E MAGURA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGURA
Provider First Name:
CHRISTIAN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205809787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9735 KINCEY AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-9118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-414-2870
Provider Business Mailing Address Fax Number:
704-414-2860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-1194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-327-1116
Provider Business Practice Location Address Fax Number:
803-327-6872
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  30064 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 9115 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27385 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 890538F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091153 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0411179 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 760691 . This is a "GREAT WEST HLTHCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 89136H2 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136H2 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1905781 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 279870 . This is a "MAMSI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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