Provider Demographics
NPI:1619919719
Name:AGNELLO, CHRISTINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 PEACH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2134
Mailing Address - Country:US
Mailing Address - Phone:814-877-8140
Mailing Address - Fax:814-877-8141
Practice Address - Street 1:1700 PEACH ST STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2134
Practice Address - Country:US
Practice Address - Phone:814-877-8140
Practice Address - Fax:814-877-8141
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052067L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
323586OtherUPMC
PA0014630430007Medicaid
PA402159OtherHIGHMARK BLUE SHIELD
115049OtherHEALTHAMERICA
323586OtherUPMC
115049OtherHEALTHAMERICA
323586OtherUPMC