Provider Demographics
NPI:1154632172
Name:CHRISTAKIS, MARKELLA MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MARKELLA
Middle Name:MICHAEL
Last Name:CHRISTAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-403-4310
Mailing Address - Fax:631-403-4312
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-403-4310
Practice Address - Fax:631-403-4312
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257297208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery