1891725636 NPI number — CHRISTOPHER E MCILTROT MD PA

Table of content: (NPI 1891725636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891725636 NPI number — CHRISTOPHER E MCILTROT MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER E MCILTROT MD PA
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:
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:
1891725636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28145-2148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-638-5436
Provider Business Mailing Address Fax Number:
704-638-5438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 DORSETT DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-638-5436
Provider Business Practice Location Address Fax Number:
704-638-5438
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCILTROT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-638-5436

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  9900937 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE1950 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1223N . This is a "NORTH CAROLINA BC BS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com