Provider Demographics
NPI:1275575185
Name:MAISEL, CHRISTOPHER MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARC
Last Name:MAISEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1000
Practice Address - Fax:214-370-1202
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2386207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U3556OtherBLUE CROSS OF TX
TX176333602Medicaid
TX176333601Medicaid
TXP00294917Medicare PIN
TX8D9076Medicare PIN
TX176333601Medicaid
TX8J7119Medicare PIN