Provider Demographics
NPI:1790006526
Name:VIAGRANDE, CHRISTOPHER (NPP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:VIAGRANDE
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALBIN RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4122
Mailing Address - Country:US
Mailing Address - Phone:845-518-7167
Mailing Address - Fax:518-670-9636
Practice Address - Street 1:15 ALBIN RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-4122
Practice Address - Country:US
Practice Address - Phone:845-518-7167
Practice Address - Fax:518-670-9636
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401279363LP0808X
NYF401279-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY401279OtherOFFICE OF THE PROFESSIONS
NY826669222OtherNYS DMV