Provider Demographics
NPI:1104051150
Name:BATTLE, CHRISTAN M (PA STUDENT)
Entity type:Individual
Prefix:
First Name:CHRISTAN
Middle Name:M
Last Name:BATTLE
Suffix:
Gender:
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 TWILIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8393
Mailing Address - Country:US
Mailing Address - Phone:407-301-6134
Mailing Address - Fax:
Practice Address - Street 1:15459 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1847
Practice Address - Country:US
Practice Address - Phone:240-544-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1003X, 390200000X
MDC0009864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program