Provider Demographics
NPI:1649566423
Name:ULLMAN, CHRISTINE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3211
Mailing Address - Country:US
Mailing Address - Phone:540-674-8805
Mailing Address - Fax:540-674-8670
Practice Address - Street 1:118 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3211
Practice Address - Country:US
Practice Address - Phone:540-674-8805
Practice Address - Fax:540-674-8670
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023873207Q00000X
VA0102-203739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVE991AOtherMEDICARE PTAN