Provider Demographics
NPI:1164495925
Name:LAKY, CHRISTINE AJJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:AJJAN
Last Name:LAKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:BARBARA
Other - Last Name:AJJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-4442
Practice Address - Fax:410-224-8898
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8587207V00000X
CT047348207VM0101X
MDD85984207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222363500Medicaid
MDK480009OtherCAREFIRST BCBS
MD716871OtherMEDICARE
MD716876OtherMEDICARE