Provider Demographics
NPI:1902040306
Name:ORR, CHRISTOPHER DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:ORR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 HUMPHREY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8738
Mailing Address - Country:US
Mailing Address - Phone:619-933-8590
Mailing Address - Fax:440-579-0187
Practice Address - Street 1:1701 MENTOR AVE STE 10
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1459
Practice Address - Country:US
Practice Address - Phone:619-933-8590
Practice Address - Fax:440-579-0187
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20215363A00000X
OH50.003532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048816199IGOtherCARESOURCE
OH50.003532OtherLICENSE
OH0068337Medicaid
OH9004917OtherAETNA
OH0068337Medicaid