Provider Demographics
NPI:1063487130
Name:LISTROM, CHAD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DAVID
Last Name:LISTROM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 KINGSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6949
Mailing Address - Country:US
Mailing Address - Phone:910-215-9910
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine