Provider Demographics
NPI:1780928481
Name:BOATWRIGHT, CHRISTOPHER B (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S UNION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4355
Mailing Address - Country:US
Mailing Address - Phone:330-596-6500
Mailing Address - Fax:330-596-6505
Practice Address - Street 1:1900 S UNION AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4355
Practice Address - Country:US
Practice Address - Phone:330-596-6500
Practice Address - Fax:330-596-6505
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50003620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant