Provider Demographics
NPI:1609194596
Name:CLARK, CHRISTINA BLUME (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:BLUME
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LOUISE BLUME
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT. OF RADIOLOGY UNIVERSITY OF LOUISVILLE HOSPITAL
Mailing Address - Street 2:530 SOUTH JACKSON STREET, CCB-C07
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-5875
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY UNIVERSITY OF LOUISVILLE HOSP.
Practice Address - Street 2:530 SOUTH JACKSON STREET CCB-C07
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY506022085R0202X
PAMD4617412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology