Provider Demographics
NPI:1417055393
Name:CHRISTA M GREDLEIN D P M P A
Entity Type:Organization
Organization Name:CHRISTA M GREDLEIN D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GREDLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-833-9353
Mailing Address - Street 1:100 OWINGS CT
Mailing Address - Street 2:SUITE 14
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6428
Mailing Address - Country:US
Mailing Address - Phone:410-833-9353
Mailing Address - Fax:410-833-9550
Practice Address - Street 1:100 OWINGS CT
Practice Address - Street 2:SUITE 14
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6428
Practice Address - Country:US
Practice Address - Phone:410-833-9353
Practice Address - Fax:410-833-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01332213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5765260001Medicare NSC