Provider Demographics
NPI:1669432043
Name:QUE, CHRIS CLINTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:CLINTON
Last Name:QUE
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 1:3409 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5438
Mailing Address - Country:US
Mailing Address - Phone:743-229-3300
Mailing Address - Fax:743-229-3324
Practice Address - Street 1:3409 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5438
Practice Address - Country:US
Practice Address - Phone:743-229-3300
Practice Address - Fax:743-229-3324
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02002207R00000X
WV20638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019557670001Medicaid
WV1840301000Medicaid
MD413144400Medicaid
WV1840301-000Medicaid
PA1019557670001Medicaid
WVQU6036110Medicare PIN
WVH52199Medicare UPIN
MD413144400Medicaid