Provider Demographics
NPI:1366039828
Name:CHRISTIAN, ROBERT PATRICK (PRSS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PATRICK
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LEFTWICH AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1328
Mailing Address - Country:US
Mailing Address - Phone:304-601-2279
Mailing Address - Fax:
Practice Address - Street 1:347 KENMORE DR STE 1A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7083
Practice Address - Country:US
Practice Address - Phone:304-369-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant