Provider Demographics
NPI:1104973072
Name:BRANNER, CHRISTOPHER MALCOLM (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MALCOLM
Last Name:BRANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2803
Practice Address - Country:US
Practice Address - Phone:704-304-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104973072Medicaid
SCN0075HMedicaid
NC5907667Medicaid
NCNC8382GMedicare PIN
NCNC8382PMedicare PIN
NCNC8382JMedicare PIN
NC5907667Medicaid
NCNC8382HMedicare PIN
NCNC8382MMedicare PIN
NCNC8382BMedicare PIN
NCNC8382AMedicare PIN
NC1104973072Medicaid
NCNC8382IMedicare PIN
NCNC8382NMedicare PIN
NCNC8382OMedicare PIN
NCNC8382DMedicare PIN
NCNC8382FMedicare PIN
NCNC8382LMedicare PIN
NCNC8382CMedicare PIN