Provider Demographics
NPI:1114159324
Name:FOTOPOULOS, CHRISTINA LYNN
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:FOTOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 WINDSOR GATE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2929
Mailing Address - Country:US
Mailing Address - Phone:757-463-0099
Mailing Address - Fax:
Practice Address - Street 1:241 WINSHIRE ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4931
Practice Address - Country:US
Practice Address - Phone:757-871-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist