Provider Demographics
NPI:1083681795
Name:KANNLER, CHRISTINE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:KANNLER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MERRIMACK ST STE 311
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:138 CONANT ST STE 1
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1666
Practice Address - Country:US
Practice Address - Phone:978-691-5690
Practice Address - Fax:978-691-5693
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214074174400000X, 207N00000X, 207ND0101X
NH14228207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology