Provider Demographics
NPI:1356313431
Name:CHRISTIAN, EUGENE P (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:704-944-0143
Mailing Address - Fax:704-944-7399
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:704-944-0143
Practice Address - Fax:704-944-7399
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7268317OtherCIGNA HEALTHCARE ID #
NCMEDCOSTOtherMEDCOST ID #
NC1401KOtherBCBS ID #
NC561549396OtherTAX ID #
NC890238KOtherNC MEDICAID GROUP NUMBER
NC4227249OtherAETNA ID #
NC5903047Medicaid
NCE40816NMedicare UPIN
NC4227249OtherAETNA ID #