Provider Demographics
NPI:1093786683
Name:BLUE, CHRISTINE M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BLUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9503
Mailing Address - Country:US
Mailing Address - Phone:304-645-3220
Mailing Address - Fax:304-645-4103
Practice Address - Street 1:400 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9503
Practice Address - Country:US
Practice Address - Phone:304-645-3220
Practice Address - Fax:304-645-4103
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19272084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV184749000Medicaid
BL4100951Medicare ID - Type Unspecified
H78682Medicare UPIN