Provider Demographics
NPI:1760987689
Name:KOLLER, CHRISTOPHER RAYMOND
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAYMOND
Last Name:KOLLER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:RAYMOND
Other - Last Name:KOLLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1004 KINGSWOOD DR APT A
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9475
Mailing Address - Country:US
Mailing Address - Phone:919-451-7546
Mailing Address - Fax:
Practice Address - Street 1:10710 CHARTER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3258
Practice Address - Country:US
Practice Address - Phone:410-772-7000
Practice Address - Fax:410-772-7072
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
MDD0097858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program