Provider Demographics
NPI:1487797114
Name:ELLER, CHRYSTAL FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRYSTAL
Middle Name:FAYE
Last Name:ELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 ALLEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2861
Mailing Address - Country:US
Mailing Address - Phone:910-571-5510
Mailing Address - Fax:910-571-5539
Practice Address - Street 1:522 ALLEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2861
Practice Address - Country:US
Practice Address - Phone:910-571-5510
Practice Address - Fax:910-571-5539
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907325Medicaid
NC145XROtherBCBS
FH1100265OtherFIRST CAROLINA CARE
9073047OtherAETNA
NC2021823Medicare PIN