Healthcare Provider Details

I. General information

NPI: 1760485486
Provider Name (Legal Business Name): CHRISTOPHER JOHN WARNIMONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STADIUM OAKS DR
CLEMMONS NC
27012-8962
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-766-0547
  • Fax: 336-766-0549
Mailing address:
  • Phone: 336-766-0547
  • Fax: 336-766-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number95-00759
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95-00759
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier66568863
Identifier TypeOTHER
Identifier State
Identifier IssuerCHAMPUS
# 2
IdentifierP00457709
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier0402116
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE
# 4
Identifier2624329
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA HMO OPOS
# 5
Identifier58459
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDCOST
# 6
IdentifierP00165221
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 7
Identifier8985749
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 8
Identifier5296039
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA PPO POS
# 9
Identifier8119782
Identifier TypeOTHER
Identifier State
Identifier IssuerMAMSI
# 10
Identifier85749
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 11
Identifier10527
Identifier TypeOTHER
Identifier State
Identifier IssuerPARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: