Provider Demographics
NPI:1548235641
Name:PANNELL, CHRISTA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:R
Last Name:PANNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 HICKORY TREE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9243
Mailing Address - Country:US
Mailing Address - Phone:336-764-3304
Mailing Address - Fax:336-764-1018
Practice Address - Street 1:799 HICKORY TREE RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9139
Practice Address - Country:US
Practice Address - Phone:336-764-3304
Practice Address - Fax:336-764-1018
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105243OtherUNITED HEALTHCARE
NC138UAOtherBCBS NUMBER
NC7185519OtherCIGNA HEALTHCARE NUMBER
NC805412OtherPARTNER MEDICARE CHOICE
NCD7949OtherMEDCOST NUMBER
NC2127507OtherMAMSI NUMBER
NC7801618OtherAETNA NUMBER
NC5900099Medicaid
NCD7949OtherMEDCOST NUMBER
NC5900099Medicaid