Healthcare Provider Details

I. General information

NPI: 1538319223
Provider Name (Legal Business Name): CHRISTOPHER GOLDEN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 THOROUGHBRED LN
CHESAPEAKE VA
23320-3061
US

IV. Provider business mailing address

201 THOROUGHBRED LN
CHESAPEAKE VA
23320-3061
US

V. Phone/Fax

Practice location:
  • Phone: 864-283-4678
  • Fax:
Mailing address:
  • Phone: 864-283-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: