Provider Demographics
NPI:1558348953
Name:CHRISTIANSEN, DOROTHY M (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:M
Last Name:CHRISTIANSEN
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-0369
Mailing Address - Country:US
Mailing Address - Phone:978-448-4300
Mailing Address - Fax:978-448-4040
Practice Address - Street 1:100 BOSTON RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1860
Practice Address - Country:US
Practice Address - Phone:978-448-4300
Practice Address - Fax:978-448-4040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76330207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3097668Medicaid
J12702Medicare ID - Type Unspecified
MA3097668Medicaid