Provider Demographics
NPI:1487815601
Name:DICKUN, CHRISTAL M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:M
Last Name:DICKUN
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 1:125 E OTTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2509
Mailing Address - Country:US
Mailing Address - Phone:412-851-3256
Mailing Address - Fax:
Practice Address - Street 1:1400 ROCKLEDGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2846
Practice Address - Country:US
Practice Address - Phone:321-735-8960
Practice Address - Fax:321-735-8964
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124247207P00000X
NE25291207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine