Provider Demographics
NPI:1104001585
Name:HAVERSTOCK, CHRISTINA L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:HAVERSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1150
Mailing Address - Country:US
Mailing Address - Phone:336-632-9272
Mailing Address - Fax:336-632-1411
Practice Address - Street 1:510 N ELAM AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1150
Practice Address - Country:US
Practice Address - Phone:336-632-9272
Practice Address - Fax:336-632-1411
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00444207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology