Provider Demographics
NPI:1518921014
Name:DUDENHOEFER, CHRISTIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:P
Last Name:DUDENHOEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2059 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4741
Mailing Address - Country:US
Mailing Address - Phone:814-459-6777
Mailing Address - Fax:814-459-6367
Practice Address - Street 1:1101 PENINSULA DR STE 202
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4169
Practice Address - Country:US
Practice Address - Phone:814-833-5381
Practice Address - Fax:814-833-5387
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043235L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE84747Medicare UPIN
PA671081Medicare ID - Type Unspecified