Provider Demographics
NPI:1043680119
Name:CHRISTIANNE M MCGRATH MD PC
Entity Type:Organization
Organization Name:CHRISTIANNE M MCGRATH MD PC
Other - Org Name:ALLIGATOR ALLERGY & ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-344-5355
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8731
Mailing Address - Country:US
Mailing Address - Phone:719-344-5355
Mailing Address - Fax:719-375-8381
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 212
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-344-5355
Practice Address - Fax:719-375-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0052618261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12152323Medicaid
1568600450OtherPRACTITIONER NPI
CODR0052618OtherMD LICENSE
1568600450OtherPRACTITIONER NPI
CO12152323Medicaid