Healthcare Provider Details

I. General information

NPI: 1649361601
Provider Name (Legal Business Name): CHRISTOPHER JOHN MAGRYTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WOODSON ST
SALISBURY NC
28144-3255
US

IV. Provider business mailing address

129 WOODSON ST
SALISBURY NC
28144-3255
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5576
  • Fax: 704-636-1755
Mailing address:
  • Phone: 704-636-5576
  • Fax: 704-636-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9900593
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number9900593
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number9900593
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9900593
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9900593
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: