Provider Demographics
NPI:1669439386
Name:MADSEN, CHRISTIAN V (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:V
Last Name:MADSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WEST WT HARRIS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206
Mailing Address - Country:US
Mailing Address - Phone:704-342-9011
Mailing Address - Fax:704-342-3812
Practice Address - Street 1:9200 WEST WT HARRIS BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269
Practice Address - Country:US
Practice Address - Phone:704-342-9011
Practice Address - Fax:704-342-3812
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26210202C00000X
NC26120207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2075404Medicare UPIN
NC2347894Medicare PIN
C81460Medicare UPIN