Provider Demographics
NPI:1033433099
Name:EIDE, CHRISTINA T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:T
Last Name:EIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 SENECA ST
Mailing Address - Street 2:MS H8-GME
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2742
Mailing Address - Country:US
Mailing Address - Phone:206-583-6079
Mailing Address - Fax:206-583-2307
Practice Address - Street 1:1229 MADISON ST STE 1440
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3538
Practice Address - Country:US
Practice Address - Phone:206-625-0578
Practice Address - Fax:206-625-9184
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60464753207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8930964OtherMEDICARE