Provider Demographics
NPI:1174673867
Name:CHRISTIE MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:CHRISTIE MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-224-2880
Mailing Address - Street 1:2661 RIVA RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7353
Mailing Address - Country:US
Mailing Address - Phone:410-224-2880
Mailing Address - Fax:410-224-7828
Practice Address - Street 1:2661 RIVA RD
Practice Address - Street 2:SUITE 610
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7353
Practice Address - Country:US
Practice Address - Phone:410-224-2880
Practice Address - Fax:410-224-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3125734OtherMAMSI UNITED HEALTHCARE
DCJ710OtherBCBS OF NCA
MDP00157968OtherRAILROAD MEDICARE
MD793ACHOtherBCBS OF MD.
MD496856OtherNCPPO UNICARE
MD496856OtherNCPPO UNICARE
MDP00157968OtherRAILROAD MEDICARE