Provider Demographics
NPI:1073679908
Name:TEIMOURI, CHRISTINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:TEIMOURI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-0309
Mailing Address - Country:US
Mailing Address - Phone:878-313-3338
Mailing Address - Fax:878-313-3339
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:STE 101
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:878-313-3338
Practice Address - Fax:878-313-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004042L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015190500007Medicaid
PA532891TXMMedicare PIN
PA0015190500007Medicaid