Provider Demographics
NPI:1255313813
Name:ODELL, CHRISTINE A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:ODELL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:LICHTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 SARGENT DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6100
Mailing Address - Country:US
Mailing Address - Phone:203-781-4321
Mailing Address - Fax:203-781-4329
Practice Address - Street 1:150 SARGENT DR
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6100
Practice Address - Country:US
Practice Address - Phone:203-781-4321
Practice Address - Fax:203-781-4329
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053435208000000X
MA2202212080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2037696Medicaid
VAC06778OtherGROUP PTAN
CT008055097Medicaid
VAC09463OtherGROUP PTAN
CT008055097Medicaid