Provider Demographics
NPI:1144229568
Name:ANDERSON, CHRISTINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:ANDERSON
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 1:19 FEDERAL CORNER RD
Mailing Address - Street 2:
Mailing Address - City:CENTER TUFTONBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03816-5600
Mailing Address - Country:US
Mailing Address - Phone:603-569-7712
Mailing Address - Fax:
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:MEDICAL ARTS BUILDING STE A
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-569-7574
Practice Address - Fax:603-569-7582
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201516Medicaid
NHH30204Medicare UPIN
NHRE6228Medicare ID - Type UnspecifiedINDIVIDUAL PROV NUMBER