Provider Demographics
NPI:1770809089
Name:STANLEY, CHRISTOPHER MARTIN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:STANLEY
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 1:8203 NIGELS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4177
Mailing Address - Country:US
Mailing Address - Phone:438-491-1630
Mailing Address - Fax:843-491-1634
Practice Address - Street 1:8203 NIGELS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4177
Practice Address - Country:US
Practice Address - Phone:438-491-1630
Practice Address - Fax:843-491-1634
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39731207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107666Medicaid