Provider Demographics
NPI:1407844970
Name:LOPEZ, CHRISTINA BOHNERT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:BOHNERT
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BONHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7340 E BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9625
Practice Address - Country:US
Practice Address - Phone:614-864-8000
Practice Address - Fax:614-864-3036
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2323177Medicaid
OHBO4084471Medicare PIN