Basic Information
| Provider Information | |||||||||
| NPI: | 1346239522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACOMBER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 PRESTON EXECUTIVE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198523999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 PRESTON EXECUTIVE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198523999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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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 | 208000000X | 2007--1387 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3198669 | 05 | MA | MEDICAID |