Provider Demographics
NPI:1598260119
Name:KELLOGG, CHRISTOPHER ALLAN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLAN
Last Name:KELLOGG
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 1:53-59 PUBLIC SQ STE 301
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-782-2141
Mailing Address - Fax:315-782-2141
Practice Address - Street 1:53-59 PUBLIC SQ STE 301
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-782-2141
Practice Address - Fax:315-782-5123
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308621207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine