Healthcare Provider Details

I. General information

NPI: 1225084395
Provider Name (Legal Business Name): CHRISTOPHER J WAHLGREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 FALLS RD
LUTHERVILLE MD
21093-4515
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 321-442-7156
  • Fax: 410-955-9062
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101042670
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD57957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: