Provider Demographics
NPI:1780685040
Name:MONTAGANO, CHRISTIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:MONTAGANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 N PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2730
Mailing Address - Country:US
Mailing Address - Phone:864-305-5000
Mailing Address - Fax:864-840-8207
Practice Address - Street 1:2498 N PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2730
Practice Address - Country:US
Practice Address - Phone:864-305-5000
Practice Address - Fax:864-840-8207
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501214207P00000X
SC1217207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901496Medicaid
NC1408GOtherBCBS GROUP # 015CK
SCAA33048510Medicare PIN
NC1408GOtherBCBS GROUP # 015CK
NC5901496Medicaid
NCH60541Medicare UPIN