Provider Demographics
NPI:1093734691
Name:ANDERSEN, CHRISTINE H (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:H
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 HAVERHILL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1509
Mailing Address - Country:US
Mailing Address - Phone:978-475-4322
Mailing Address - Fax:978-474-4537
Practice Address - Street 1:138 HAVERHILL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1509
Practice Address - Country:US
Practice Address - Phone:978-475-4322
Practice Address - Fax:978-474-4537
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152281207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401021OtherHARVARD
MA33475OtherFALLON
MAJ18485OtherBLUE CROSS/BLUE SHIELD
MA0300326OtherUNITED HEALTHCARE
MA152281OtherTUFTS
G51929Medicare UPIN
A22854Medicare ID - Type Unspecified