Provider Demographics
NPI:1912978503
Name:ENOCH, CHRISTOPHER A (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:ENOCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BELMONT AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1125
Mailing Address - Country:US
Mailing Address - Phone:330-746-1488
Mailing Address - Fax:330-746-5611
Practice Address - Street 1:1340 BELMONT AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1125
Practice Address - Country:US
Practice Address - Phone:330-746-1488
Practice Address - Fax:330-746-5611
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007892E207RN0300X
PAOS010186L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01766337Medicaid
PA01766337Medicaid
H21553Medicare UPIN
OHEN4090391Medicare ID - Type Unspecified