Provider Demographics
NPI:1740283142
Name:LIGE, CHRISTIAN THOR (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:THOR
Last Name:LIGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5107 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3989
Mailing Address - Country:US
Mailing Address - Phone:252-255-5321
Mailing Address - Fax:252-565-0534
Practice Address - Street 1:400 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8895
Practice Address - Country:US
Practice Address - Phone:252-449-5200
Practice Address - Fax:252-565-0534
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132G8Medicaid
NC89132G8Medicaid