Provider Demographics
NPI:1528189958
Name:SHORT, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SHORT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MECHANIC FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04256-6108
Mailing Address - Country:US
Mailing Address - Phone:207-345-9729
Mailing Address - Fax:207-345-9421
Practice Address - Street 1:22 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MECHANIC FALLS
Practice Address - State:ME
Practice Address - Zip Code:04256-6108
Practice Address - Country:US
Practice Address - Phone:207-345-9729
Practice Address - Fax:207-345-9421
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME15952083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME306820099Medicaid
MEMM73901Medicare PIN