Provider Demographics
NPI:1003182114
Name:CHRISTIAN, KACI ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:ELIZABETH
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:ELIZABETH
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-869-4600
Mailing Address - Fax:717-544-3501
Practice Address - Street 1:2112 HARRISBURG PIKE STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-869-4600
Practice Address - Fax:717-544-3501
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466518207RG0100X
MDD79653208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036159890001Medicaid
PA792620OtherMEDICARE
PA1036159890002Medicaid
PAMD466518OtherMEDICAL LICENSE
PA1036159890003Medicaid
PA1036159890003Medicaid