Provider Demographics
NPI:1245426667
Name:CHRISTIAN G ANDERSON MD PA
Entity Type:Organization
Organization Name:CHRISTIAN G ANDERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-734-0576
Mailing Address - Street 1:502 W KING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3362
Mailing Address - Country:US
Mailing Address - Phone:704-734-0576
Mailing Address - Fax:704-730-1712
Practice Address - Street 1:502 W KING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3362
Practice Address - Country:US
Practice Address - Phone:704-734-0576
Practice Address - Fax:704-730-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911190Medicaid
NC8911190Medicaid