Provider Demographics
NPI:1508803958
Name:PRIEST, CHRISTINE ANN I (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:PRIEST
Suffix:I
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:PRIEST BALDI
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:100 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1146
Mailing Address - Country:US
Mailing Address - Phone:856-396-0183
Mailing Address - Fax:856-810-9889
Practice Address - Street 1:127 CHURCH RD
Practice Address - Street 2:100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9402
Practice Address - Country:US
Practice Address - Phone:856-810-9888
Practice Address - Fax:856-810-9889
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00134900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095159CQNMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID #
NJQ54444Medicare UPIN