=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891725636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER E MCILTROT MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 01/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 DORSETT DR SUITE A
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-638-5436
-----------------------------------------------------
Fax | 704-638-5438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2148
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28145-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-638-5436
-----------------------------------------------------
Fax | 704-638-5438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER EUGENE MCILTROT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 704-638-5436
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 9900937
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------