Healthcare Provider Details

I. General information

NPI: 1285626481
Provider Name (Legal Business Name): CHRISTOPHER J ACKERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SHARP ST
LAWRENCEVILLE VA
23868-1615
US

IV. Provider business mailing address

PO BOX 459
LAWRENCEVILLE VA
23868-0459
US

V. Phone/Fax

Practice location:
  • Phone: 434-848-0771
  • Fax: 434-848-3814
Mailing address:
  • Phone: 434-848-0771
  • Fax: 434-848-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101044297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: