Provider Demographics
NPI:1568600450
Name:MCGRATH, CHRISTIANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANNE
Middle Name:MARIE
Last Name:MCGRATH
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 1:4194 ROYAL PINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1639
Mailing Address - Country:US
Mailing Address - Phone:719-344-5355
Mailing Address - Fax:844-269-5420
Practice Address - Street 1:4194 ROYAL PINE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1639
Practice Address - Country:US
Practice Address - Phone:719-344-5355
Practice Address - Fax:844-269-5420
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52618207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12152323Medicaid
CO473725091OtherEIN MUST BE ASSOCIATED WITH MY NPI
CO12152323Medicaid
CO297382YLJVMedicare PIN