Healthcare Provider Details

I. General information

NPI: 1750313045
Provider Name (Legal Business Name): CHRISTOPHER LOCKHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH COLUMBIA RD - ALTRU HEALTH SYSTEM
GRAND FORKS ND
58201
US

IV. Provider business mailing address

PO BOX 6002
GRAND FORKS ND
58206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax:
Mailing address:
  • Phone: 701-780-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number11627
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA65678
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA65678
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number11627
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: