Provider Demographics
NPI:1043474844
Name:KING, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HANSHAW ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1871
Mailing Address - Country:US
Mailing Address - Phone:607-273-6757
Mailing Address - Fax:607-273-2854
Practice Address - Street 1:905 HANSHAW ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1871
Practice Address - Country:US
Practice Address - Phone:607-273-6757
Practice Address - Fax:607-273-2854
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY422432084N0400X, 2084N0400X
NY2886162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTP985OtherKY TEMP LICENSE
KY0228OtherMEDICARE GROUP
KY42243OtherKENTUCKY BOARD OF MEDICAL LICENSURE: LICENSE