Provider Demographics
NPI:1760987689
Name:KOLLER, CHRISTOPHER RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RAYMOND
Last Name:KOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:RAYMOND
Other - Last Name:KOLLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1004 KINGSWOOD DR APT A
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9475
Mailing Address - Country:US
Mailing Address - Phone:919-451-7546
Mailing Address - Fax:
Practice Address - Street 1:1 METRO BLVD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014
Practice Address - Country:US
Practice Address - Phone:973-230-6666
Practice Address - Fax:973-230-6686
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0097858208800000X
LA390200000X
NJ25MA12793000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program