Provider Demographics
NPI:1083674337
Name:CHRISTIANSON, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:501 N COLUMBIA RD
Mailing Address - Street 2:DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9037
Mailing Address - Country:US
Mailing Address - Phone:701-777-3240
Mailing Address - Fax:701-777-4849
Practice Address - Street 1:501 COLUMBIA RD
Practice Address - Street 2:DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9037
Practice Address - Country:US
Practice Address - Phone:701-777-3240
Practice Address - Fax:701-777-4849
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND9006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11834Medicaid
NDC62458Medicare UPIN
ND25284Medicare ID - Type Unspecified