Provider Demographics
NPI:1184037004
Name:DARE, CHRISTOPHER (SARIDC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DARE
Suffix:
Gender:M
Credentials:SARIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6839 BALTIMORE RD
Mailing Address - Street 2:
Mailing Address - City:TARAWA TERRACE
Mailing Address - State:NC
Mailing Address - Zip Code:28543-1403
Mailing Address - Country:US
Mailing Address - Phone:240-320-4704
Mailing Address - Fax:
Practice Address - Street 1:3D MSOB
Practice Address - Street 2:PSC BOX 20073
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28546-0073
Practice Address - Country:US
Practice Address - Phone:240-320-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman