Provider Demographics
NPI:1598941601
Name:CHRISTOPHER M. DEAKIN, M.D. PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER M. DEAKIN, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-1360
Mailing Address - Street 1:4140 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4341
Mailing Address - Country:US
Mailing Address - Phone:716-634-1360
Mailing Address - Fax:
Practice Address - Street 1:4140 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4341
Practice Address - Country:US
Practice Address - Phone:716-634-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223952261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health