Provider Demographics
NPI:1336316819
Name:TEBBIT, CHRISTOPHER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:TEBBIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:400 PARK ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3368
Practice Address - Country:US
Practice Address - Phone:704-295-3700
Practice Address - Fax:704-295-3707
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110489207Y00000X
NC2009-00715207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20099611OtherSELECT HEALTH OF SC
9353337OtherAETNA
P00811880OtherRAILROAD MEDICARE
NC5911997Medicaid
SCN00712Medicaid
NC1534JOtherBCBSNC
SC20099611OtherSELECT HEALTH OF SC