Basic Information
| Provider Information | |||||||||
| NPI: | 1336316819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEBBIT | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953700 | ||||||||
| FaxNumber: | 7042953707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 110489 | NC | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 2009-00715 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 20099611 | 01 | SC | SELECT HEALTH OF SC | OTHER | 9353337 | 01 | AETNA | OTHER | P00811880 | 01 | RAILROAD MEDICARE | OTHER | 5911997 | 05 | NC | MEDICAID | N00712 | 05 | SC | MEDICAID | 1534J | 01 | NC | BCBSNC | OTHER |