Provider Demographics
NPI:1679651699
Name:LANCIONI, CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LANCIONI
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 1:707 SW GAINES ST
Mailing Address - Street 2:CDRC-P
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2901
Mailing Address - Country:US
Mailing Address - Phone:503-494-3305
Mailing Address - Fax:503-494-1542
Practice Address - Street 1:707 SW GAINES ST
Practice Address - Street 2:CDRC-P
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2901
Practice Address - Country:US
Practice Address - Phone:503-494-3305
Practice Address - Fax:503-494-1542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087984208000000X
OH0879842080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020905740001OtherPA MEDICAID
OH2738881OtherBCMH
OH2738881Medicaid
OH750822OtherBUCKEYE
OH000000526063OtherANTHEM
OH363730OtherWELLCARE
OH7757588OtherAETNA
OH000000221093OtherUNISON
I33612Medicare UPIN
OH2738881Medicaid