Healthcare Provider Details

I. General information

NPI: 1598019937
Provider Name (Legal Business Name): CHRISTIAN ESTRADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 01/18/2023
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 OAK LN STE 202
LYNCHBURG VA
24503-2513
US

IV. Provider business mailing address

1330 OAK LN STE 202
LYNCHBURG VA
24503-2513
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-4175
  • Fax: 434-200-4175
Mailing address:
  • Phone: 434-200-4175
  • Fax: 434-200-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101262332
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09918800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: