Provider Demographics
NPI:1417006131
Name:CHRISMON, DENNIS (PA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:CHRISMON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 KIRKPATRICK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8148
Mailing Address - Country:US
Mailing Address - Phone:336-584-3100
Mailing Address - Fax:
Practice Address - Street 1:1041 KIRKPATRICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8148
Practice Address - Country:US
Practice Address - Phone:336-584-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP18761Medicare UPIN