Provider Demographics
NPI:1093791097
Name:VAGNONI, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:VAGNONI
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 1:800 N FANT STREET
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-314-8549
Mailing Address - Fax:864-512-2020
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:864-314-8549
Practice Address - Fax:864-512-2020
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35521207R00000X, 208M00000X
MDD0059987207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ697 002OtherBLUE CHOICE
MDP00135051OtherTRAVELERS MEDICARE
MD404927600 01Medicaid
WV1812767000Medicaid
MD641385 02OtherCAREFIRST BC BS
MD641385 01OtherCAREFIRST BC BS
DCJ697 002OtherBLUE CHOICE
MDI712Medicare PIN