Provider Demographics
NPI:1457384232
Name:WATHEN, CHRISTIAN F (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:F
Last Name:WATHEN
Suffix:
Gender:F
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 1498
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-1498
Mailing Address - Country:US
Mailing Address - Phone:804-725-0100
Mailing Address - Fax:804-725-3158
Practice Address - Street 1:9184 BUCKLEY HALL RD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109-2309
Practice Address - Country:US
Practice Address - Phone:804-725-0100
Practice Address - Fax:804-725-3158
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVN295G461Medicare PIN
VA015540R53Medicare PIN
VA1457384232Medicaid
H62090Medicare UPIN