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NPI Code Detail

MEDICARE: DR. CARROLL D CHRISTIANSEN M.D.

MEDICARE: DR. CARROLL D CHRISTIANSEN M.D.
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
1207Q00000XFamily Medicine Physician12660WV

Other Identifiers

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

General Provider Information

NPI Number : 1801898861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARROLL D CHRISTIANSEN M.D.
Provider Business Mailing Address
First Line : 146 WILLIAMS DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1826
Country : US
Telephone Number : 304-927-1495
Fax Number : 304-927-5813
Provider Business Practice Location Address
First Line : 146 WILLIAMS DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1826
Country : US
Telephone Number : 304-927-1495
Fax Number : 304-927-5813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 07/08/2007

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