Provider Demographics
NPI:1013202803
Name:WANJERI-HASEN, CHRISTINE T (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:T
Last Name:WANJERI-HASEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:T
Other - Last Name:WANJERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8099
Practice Address - Street 1:2966 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2604
Practice Address - Country:US
Practice Address - Phone:215-638-0666
Practice Address - Fax:215-638-3320
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016853207Q00000X
PAOT014057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES0000Medicare UPIN