Provider Demographics
NPI:1467670927
Name:WILLIS, CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:SUITE #201
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1629
Mailing Address - Country:US
Mailing Address - Phone:860-803-7363
Mailing Address - Fax:401-886-7883
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:SUITE #201
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1629
Practice Address - Country:US
Practice Address - Phone:860-803-7363
Practice Address - Fax:401-886-7883
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics