Provider Demographics
NPI:1629269139
Name:L. GLENN CHRISTIE MD LTD
Entity Type:Organization
Organization Name:L. GLENN CHRISTIE MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-282-7872
Mailing Address - Street 1:7605 FOREST AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4939
Mailing Address - Country:US
Mailing Address - Phone:804-282-7872
Mailing Address - Fax:804-288-4318
Practice Address - Street 1:7605 FOREST AVE STE 402
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4939
Practice Address - Country:US
Practice Address - Phone:804-282-7872
Practice Address - Fax:804-288-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101013228173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087586OtherANTHEM
VA7303951Medicaid
VAC01957Medicare PIN
VA7303951Medicaid