Provider Demographics
NPI:1609884956
Name:GREDLEIN, CHRISTA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:M
Last Name:GREDLEIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-833-9353
Mailing Address - Fax:410-584-1873
Practice Address - Street 1:4821 BUTLER RD STE 2D
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21136-5688
Practice Address - Country:US
Practice Address - Phone:410-833-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD01332213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5765260001Medicare NSC