Provider Demographics
NPI:1265681969
Name:KING, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 PEACH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 PEACH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2769
Practice Address - Country:US
Practice Address - Phone:814-877-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine