Provider Demographics
NPI:1437111531
Name:WRIGHT, CHRISTOPHER LANCE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LANCE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COULTER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1122
Mailing Address - Country:US
Mailing Address - Phone:315-462-1560
Mailing Address - Fax:315-462-6636
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-1560
Practice Address - Fax:315-462-6636
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101540BJOtherPREFERRED CARE
NYP020197094OtherBLUE SHIELD OF ROCHESTER
P030197094OtherROCHESTER BLUE SHIELD
NY01652015Medicaid
NYP010197094OtherBC/BS OF ROCHESTER
P00346636OtherRAILROAD MEDICARE
NY5926199OtherAETNA PROVIDER ID
P010197094OtherMONROE PLAN
P00346636OtherRAILROAD MEDICARE
P030197094OtherROCHESTER BLUE SHIELD
NYRA9997Medicare PIN