Provider Demographics
NPI:1215030648
Name:WESCOTT, CHRISTINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:A
Last Name:WESCOTT
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 1:8311 MAGNOLIA ESTATES DRIVE STE E
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-0000
Mailing Address - Country:US
Mailing Address - Phone:704-895-9060
Mailing Address - Fax:704-895-6494
Practice Address - Street 1:8311 MAGNOLIA ESTATES DR STE E
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8067
Practice Address - Country:US
Practice Address - Phone:704-895-9060
Practice Address - Fax:704-895-6494
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601502208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010184550Medicaid
008636M93Medicare ID - Type Unspecified
VA010184550Medicaid