Healthcare Provider Details

I. General information

NPI: 1124559935
Provider Name (Legal Business Name): CHRISTOPHER LAWRENCE MINOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PELHAM ST
METHUEN MA
01844-2060
US

IV. Provider business mailing address

147 PELHAM ST
METHUEN MA
01844-2060
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-3491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number319740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: