Provider Demographics
NPI:1609166529
Name:WOHLGEHAGEN, CRISTINA ROSAMARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:ROSAMARIA
Last Name:WOHLGEHAGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CRISTINA
Other - Middle Name:ROSAMARIA
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST STE 330
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8368
Practice Address - Country:US
Practice Address - Phone:903-606-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP99902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360593303Medicaid
TXP02531911OtherMEDICARE RAIL ROAD
TX8MP178OtherBCBS