Provider Demographics
NPI:1518957752
Name:SCIRICA, CHRISTINA VESTERGAARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:VESTERGAARD
Last Name:SCIRICA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8707
Mailing Address - Fax:617-724-2803
Practice Address - Street 1:275 CAMBRIDGE ST., STE 530
Practice Address - Street 2:MASS GENERAL HOSPITAL FOR CHILDREN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3130
Practice Address - Country:US
Practice Address - Phone:617-726-8707
Practice Address - Fax:617-724-2803
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-05-15
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Provider Licenses
StateLicense IDTaxonomies
MA215952208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2001853Medicaid
MAJ25803OtherBCBS MA
MA215952OtherTUFTS HEALTH PLAN
H78370Medicare UPIN
MAA35022Medicare ID - Type Unspecified