Provider Demographics
NPI:1093773814
Name:SICKLE, CHRISTINE A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:SICKLE
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 1:1515 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1803
Mailing Address - Country:US
Mailing Address - Phone:413-782-7646
Mailing Address - Fax:
Practice Address - Street 1:1515 ALLEN ST, SUITE B
Practice Address - Street 2:SUMNER PEDIATRICS, PC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-782-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF29263Medicare UPIN