Provider Demographics
NPI:1437165842
Name:CHRISTOPHER E MCILTROT, MD, PA
Entity Type:Organization
Organization Name:CHRISTOPHER E MCILTROT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCILTROT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-639-1478
Mailing Address - Street 1:611 MOCKSVILLE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2705
Mailing Address - Country:US
Mailing Address - Phone:704-642-0823
Mailing Address - Fax:704-642-0884
Practice Address - Street 1:611 MOCKSVILLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2705
Practice Address - Country:US
Practice Address - Phone:704-642-0823
Practice Address - Fax:704-642-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900937208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G95107Medicare UPIN