Provider Demographics
NPI:1033129499
Name:DEGNON, CHRISTINE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:DEGNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DEGNON
Other - Last Name:MCFARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1409 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1610
Mailing Address - Country:US
Mailing Address - Phone:302-786-0828
Mailing Address - Fax:302-200-8257
Practice Address - Street 1:1409 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1610
Practice Address - Country:US
Practice Address - Phone:302-786-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058087207Q00000X
FLME111108207Q00000X
TXQ9145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA251294760DOtherOLD GA MEDICAID ID FOR SCREVEN
01348056OtherAMERIGROUP
GAP00819758OtherRR MEDICARE
582162071-014OtherTRICARE AFFILIATION ID
GA251294760FMedicaid
GA1750314183OtherCOMMUNITY HEALTH CENTER
GA251294760EOtherOLD GA MEDICAID ID FOR SCREVEN
GA52222516-004OtherBCBS
GA08CBCNBOtherOLD MEDICARE PTAN FOR SCREVEN
SCGA1033Medicaid
01348056OtherAMERIGROUP
GA251294760FMedicaid
GA202I084412Medicare PIN