Provider Demographics
NPI:1093827446
Name:MEDORA, CHRISTINE RITA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RITA
Last Name:MEDORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:RITA
Other - Last Name:MEDORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:45 LYME RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1220
Mailing Address - Country:US
Mailing Address - Phone:603-643-3320
Mailing Address - Fax:603-650-0916
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:603-643-3320
Practice Address - Fax:603-643-3301
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205501Medicaid
VT1011969Medicaid
VT1011969Medicaid
H41958Medicare UPIN