Provider Demographics
NPI:1255503793
Name:DORT, CHRISTIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:DORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1036 N BROAD ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2840
Practice Address - Country:US
Practice Address - Phone:908-409-2121
Practice Address - Fax:908-409-2119
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08536300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine