MEDICARE: DR. CARRIE LYN CHAMPINE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0102203413	VA
2	207V00000X	Obstetrics & Gynecology Physician	5101015707	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922214527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE LYN CHAMPINE D.O.

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:
Fax Number	:	540-951-7427

Provider Business Practice Location Address
First Line	:	2875 BARN RD
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-6389
Country	:	US
Telephone Number	:	540-731-4578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	02/24/2024

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