Provider Demographics
NPI:1114043809
Name:CHRISTOPHER I. BECHARA, MD, PC
Entity Type:Organization
Organization Name:CHRISTOPHER I. BECHARA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:I
Authorized Official - Last Name:BECHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-368-8956
Mailing Address - Street 1:136 HIGH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-2056
Mailing Address - Country:US
Mailing Address - Phone:978-368-8956
Mailing Address - Fax:978-368-1058
Practice Address - Street 1:136 HIGH STREET EXT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2056
Practice Address - Country:US
Practice Address - Phone:978-368-8956
Practice Address - Fax:978-368-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18798OtherBCBS GROUP
MA611593OtherTUFTS GROUP
MA9732501Medicaid
MA611593OtherTUFTS GROUP
MAM18798OtherBCBS GROUP