Provider Demographics
NPI:1508362849
Name:DAVID, CHRISTOPHER NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:NICHOLAS
Last Name:DAVID
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 1:23 LEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4532
Mailing Address - Country:US
Mailing Address - Phone:248-885-1437
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST STE E37
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8604
Practice Address - Country:US
Practice Address - Phone:541-667-3740
Practice Address - Fax:541-303-8743
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00154122084P0800X
390200000X
ORMD2218142084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program