1770588238 NPI number — CHRISTOPHER GREETHAM PT

Table of content: CHRISTOPHER GREETHAM PT (NPI 1770588238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770588238 NPI number — CHRISTOPHER GREETHAM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREETHAM
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1770588238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12544 DILLINGHAM SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22192-5259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-730-6969
Provider Business Mailing Address Fax Number:
703-730-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12544 DILLINGHAM SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-5259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-730-6969
Provider Business Practice Location Address Fax Number:
703-730-1169
Provider Enumeration Date:
06/20/2005

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: 225100000X , with the licence number:  2305004216 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 265662 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: S427-0002 . This is a "CAREFIRST BCBS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".