Provider Demographics
NPI:1689623084
Name:DRY, CHRISTIE A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:A
Last Name:DRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:A
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 BULIFANTS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5747
Mailing Address - Country:US
Mailing Address - Phone:757-564-7337
Mailing Address - Fax:
Practice Address - Street 1:119 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5747
Practice Address - Country:US
Practice Address - Phone:757-564-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232821208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89065PXMedicaid
VA006735011Medicaid
VA006735011Medicaid
VA000324C38Medicare ID - Type Unspecified