Provider Demographics
NPI:1083681522
Name:AMITAY, CHRISTINE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DIANE
Last Name:AMITAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7920
Mailing Address - Country:US
Mailing Address - Phone:617-872-5223
Mailing Address - Fax:
Practice Address - Street 1:30 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4098
Practice Address - Country:US
Practice Address - Phone:857-895-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110004965AMedicaid
MA110004965AMedicaid
MAA33127Medicare ID - Type Unspecified