Basic Information
| Provider Information | |||||||||
| NPI: | 1306103403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACROSTY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TYLER | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | RENEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | CB7020 130 MASON FARM RD | ||||||||
| Address2: | 4133 BIOINFORMATICS BUILDING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662531 | ||||||||
| FaxNumber: | 9849745737 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEADOWMONT VILLAGE CIR STE 203 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275177518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849745703 | ||||||||
| FaxNumber: | 9849745737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 10/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 2017-00873 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.