Provider Demographics
NPI:1417907007
Name:DAECHER, CHRISTINE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DAECHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:EVANSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2406 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1916
Mailing Address - Country:US
Mailing Address - Phone:717-238-1010
Mailing Address - Fax:
Practice Address - Street 1:2010 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4703
Practice Address - Country:US
Practice Address - Phone:717-737-5544
Practice Address - Fax:717-214-6871
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020195140001Medicaid
PA101440Medicare PIN