Healthcare Provider Details

I. General information

NPI: 1588759989
Provider Name (Legal Business Name): CHRISTINE MARIE TANGREDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE TANGREDI BURCH M.D.

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HEMBY LN
GREENVILLE NC
27834-3773
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-9400
  • Fax: 252-744-9401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number200201564
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: