Basic Information
| Provider Information | |||||||||
| NPI: | 1306852025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | CHRISTEN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 470408 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282470408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043750100 | ||||||||
| FaxNumber: | 7043758623 | ||||||||
| Practice Location | |||||||||
| Address1: | 7845 LITTLE AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282268198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043750100 | ||||||||
| FaxNumber: | 7043758623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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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 | 207P00000X | 2006-00932 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201089 | 01 | MEDCOST | OTHER | 5907354 | 05 | NC | MEDICAID | 1432F | 01 | BCBS | OTHER | 9084107 | 01 | AETNA | OTHER | Q0093C | 05 | SC | MEDICAID | 1306852025 | 01 | NC | BCBS | OTHER | 1306852025 | 05 | NC | MEDICAID | 1306852025 | 05 | VA | MEDICAID | 3810009742 | 05 | WV | MEDICAID | 810611 | 01 | PARTNERS | OTHER |