Provider Demographics
NPI:1467553180
Name:GOLDIZEN, CRISTINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:L
Last Name:GOLDIZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-9543
Mailing Address - Country:US
Mailing Address - Phone:304-257-4128
Mailing Address - Fax:304-257-4673
Practice Address - Street 1:10 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9543
Practice Address - Country:US
Practice Address - Phone:304-257-4128
Practice Address - Fax:304-257-4673
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV176942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0116215000Medicaid
W48830Medicare UPIN