Provider Demographics
NPI:1184611485
Name:CHRISTOPHERSON, DAVID LEE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:CHRISTOPHERSON
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 PENNY LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-403-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00377558OtherRAILROAD MEDICARE PTAN, INDIVIDUAL
NC892247AOtherMEDICAID INDIVIDUAL
NC2342854OtherMEDICARE PTAN, GROUP
NC144JEOtherBCBS
NCDF5941OtherRAILROAD MEDICARE PTAN, GROUP
NC2167367DOtherMEDICARE PTAN, INDIVIDUAL
NC892247AMedicaid
NCDF5941OtherRAILROAD MEDICARE PTAN, GROUP
NCD-78503Medicare UPIN