MEDICARE: CHRISTIAN THOR LIGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	200200943	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740283142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN THOR LIGE MD

Provider Business Mailing Address
First Line	:	5107 N CROATAN HWY
Second Line	:
City	:	KITTY HAWK
State	:	NC
Zip	:	27949-3989
Country	:	US
Telephone Number	:	252-255-5321
Fax Number	:	252-565-0534

Provider Business Practice Location Address
First Line	:	400 S CROATAN HWY
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-8895
Country	:	US
Telephone Number	:	252-449-5200
Fax Number	:	252-565-0534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/04/2020

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