Provider Demographics
NPI:1255323135
Name:CHRISTIE, GREGORY JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JASON
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HAVERHILL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1504
Mailing Address - Country:US
Mailing Address - Phone:978-470-0707
Mailing Address - Fax:978-470-8973
Practice Address - Street 1:140 HAVERHILL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1504
Practice Address - Country:US
Practice Address - Phone:978-470-0707
Practice Address - Fax:978-470-8973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS24059Medicare UPIN
MACHAP0063Medicare ID - Type Unspecified