Provider Demographics
NPI:1235312158
Name:PETERS, CHRISTINA M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK CENTER DR STE 304
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9482
Mailing Address - Country:US
Mailing Address - Phone:330-336-3631
Mailing Address - Fax:330-336-3762
Practice Address - Street 1:1 PARK CENTER DR STE 304
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9482
Practice Address - Country:US
Practice Address - Phone:330-336-3631
Practice Address - Fax:330-336-3762
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4293791OtherMEDICARE ID
OH3067676Medicaid