Provider Demographics
NPI:1063495117
Name:VANDERMEER, CHRISTOPHER JOHANNUS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHANNUS
Last Name:VANDERMEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SUMMIT CROSSING PL
Mailing Address - Street 2:STE 106
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-867-8021
Mailing Address - Fax:704-864-4606
Practice Address - Street 1:620 SUMMIT CROSSING PL
Practice Address - Street 2:STE 106
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-867-8021
Practice Address - Fax:704-864-4606
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001011482085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
137Y2OtherBLUE CROSS BLUE SHIELD
560988142OtherUNITED HEALTHCARE
P00192298OtherRAILROAD MEDICARE
NC8913742Medicaid
804854OtherPARTNERS
7239629OtherAETNA PPO
SCN01141Medicaid
D4992OtherMEDCOST
3616235OtherAETNA HMO
560988142OtherUNITED HEALTHCARE
NC8913742Medicaid