Provider Demographics
NPI:1255629044
Name:POGREBA, CHRISTIAN (HIS)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:POGREBA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2242
Mailing Address - Country:US
Mailing Address - Phone:540-943-0007
Mailing Address - Fax:540-943-6717
Practice Address - Street 1:1534 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2242
Practice Address - Country:US
Practice Address - Phone:540-943-0007
Practice Address - Fax:540-943-6717
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001498235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist