Healthcare Provider Details

I. General information

NPI: 1477283257
Provider Name (Legal Business Name): CHRISTOPHER MARLOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

IV. Provider business mailing address

101 BILL BAKER WAY
BECKLEY WV
25801-1505
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8324
  • Fax:
Mailing address:
  • Phone: 304-252-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberED1147A
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: