Provider Demographics
NPI:1780858324
Name:OLIVER, CHRIS (MT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 BOBBY LN
Mailing Address - Street 2:
Mailing Address - City:SPRUCE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16683-1504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 BOBBY LN
Practice Address - Street 2:
Practice Address - City:SPRUCE CREEK
Practice Address - State:PA
Practice Address - Zip Code:16683-1504
Practice Address - Country:US
Practice Address - Phone:814-360-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103062302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization