Provider Demographics
NPI:1659890630
Name:DARE, CHRISTOPHER NATHANIEL
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NATHANIEL
Last Name:DARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3260
Mailing Address - Country:US
Mailing Address - Phone:410-449-8095
Mailing Address - Fax:
Practice Address - Street 1:406 LAKE DR UNIT 2
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-3260
Practice Address - Country:US
Practice Address - Phone:410-449-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD600115622628374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide