Healthcare Provider Details

I. General information

NPI: 1679708093
Provider Name (Legal Business Name): CHRISTOPHER TERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 SIX FORKS RD STE 100
RALEIGH NC
27609-4431
US

IV. Provider business mailing address

PO BOX 52411
PHOENIX AZ
85072-2411
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-3400
  • Fax: 919-783-7778
Mailing address:
  • Phone: 919-785-3400
  • Fax: 919-783-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number158020
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101277753
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2011-01963
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2011-01963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: