Provider Demographics
NPI:1023202769
Name:CHRISTIE, CARL L (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:L
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4496
Mailing Address - Fax:585-922-4442
Practice Address - Street 1:1415 PORTLAND AVE STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-4496
Practice Address - Fax:585-922-4442
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4267207V00000X
NJMB08459100207V00000X
NY309706207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60043860OtherHORIZON NJ HEALTH
NJ6642533/9141242OtherAETNA
NJP3944345OtherOXFORD HEALTH PLAN
NJ60043861OtherHORIZON NJ HEALTH
NJ010046653OtherAMERICHOICE
NJ2141547OtherCIGNA
NJ0175889Medicaid
NJ135668 DSQMedicare PIN
NJ0175889Medicaid