Provider Demographics
NPI:1235295239
Name:DOUMAS, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DOUMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WORLDS FAIR DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1369
Mailing Address - Country:US
Mailing Address - Phone:732-537-0909
Mailing Address - Fax:732-564-9032
Practice Address - Street 1:4810 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6952
Practice Address - Country:US
Practice Address - Phone:732-938-6090
Practice Address - Fax:732-938-5680
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08212300207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11797212OtherCAQH
NJ25MA08212300OtherLICENSE
NJ144824ZCZ1Medicare PIN