Provider Demographics
NPI:1639133903
Name:HARTER, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:SUITE A-180
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7153
Mailing Address - Country:US
Mailing Address - Phone:623-748-8300
Mailing Address - Fax:623-748-8314
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:SUITE A-180
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-748-8300
Practice Address - Fax:623-748-8314
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29110207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ850512-02Medicaid
C49222Medicare UPIN
AZ850512-02Medicaid