Provider Demographics
NPI:1679733422
Name:KNOWLTON, CHRISTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:A
Last Name:KNOWLTON
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:PO BOX 63099
Mailing Address - Street 2:DEPT. 4099
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3099
Mailing Address - Country:US
Mailing Address - Phone:203-789-3131
Mailing Address - Fax:203-789-3133
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3131
Practice Address - Fax:203-789-3133
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1898602085R0001X
CT0495962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049596OtherLICENSE
PAMY189860OtherPENNSYLVANIA MEDICAL LICENSE NUMBER