Provider Demographics
NPI:1376682104
Name:CHRISTIAN, LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3100 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2833
Mailing Address - Country:US
Mailing Address - Phone:216-751-3185
Mailing Address - Fax:
Practice Address - Street 1:6140 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3821
Practice Address - Country:US
Practice Address - Phone:440-204-4364
Practice Address - Fax:440-233-9070
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041434207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069856Medicaid
OHCH2017391Medicare ID - Type Unspecified
OH0069856Medicaid