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NPI Code Detail

MEDICARE: CHRISTOPHER JAMES VAN OOTEGHEM PA-C

MEDICARE: CHRISTOPHER JAMES VAN OOTEGHEM PA-C
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
1363A00000XPhysician Assistant104049NC
2363AM0700XMedical Physician Assistant104049NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q36915OTHERNCUPIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992709935
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER JAMES VAN OOTEGHEM PA-C
Provider Business Mailing Address
First Line : PO BOX 602195
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2195
Country : US
Telephone Number : 919-350-0351
Fax Number : 919-350-7687
Provider Business Practice Location Address
First Line : 4530 FAYETTEVILLE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27603-3614
Country : US
Telephone Number : 919-235-1930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 10/01/2025

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