Healthcare Provider Details

I. General information

NPI: 1861017949
Provider Name (Legal Business Name): CHRISTINA MARIE CERENZIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 GLENLAKE DR STE 250
CHARLOTTE NC
28208-6866
US

IV. Provider business mailing address

PO BOX 117661
ATLANTA GA
30368-7661
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5800
  • Fax: 704-626-3237
Mailing address:
  • Phone: 704-749-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2024-02386
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: