Provider Demographics
NPI:1245288307
Name:IMBER, CHRISTOPHER DEAN (M D)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DEAN
Last Name:IMBER
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CLAIRMONT CT
Mailing Address - Street 2:STE 105
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:804-504-4671
Mailing Address - Fax:804-765-6490
Practice Address - Street 1:1307 AVON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4423
Practice Address - Country:US
Practice Address - Phone:910-323-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251776207Q00000X
NC2016-02508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6990CMedicare PIN
PA069239Medicare PIN
VAVV6990AMedicare PIN
PA069239Medicare PIN
PA002717OtherFIRST PRIORITY NUMBER
PAG74994Medicare UPIN