Provider Demographics
NPI:1689668055
Name:RAY, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5241 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2391
Practice Address - Country:US
Practice Address - Phone:814-877-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070389L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
212662OtherUPMC
PA108179OtherUNISON
PA2493106OtherAETNA
OH2235969OtherOH MEDICAID
PA0018096950001Medicaid
PA080161713OtherRR MEDICARE
PA614053OtherBLUE SHIELD
NY00025357501OtherUNIVERA
NY02093007OtherNY MEDICAID
PAP001913OtherGATEWAY
PA080161713OtherRR MEDICARE
212662OtherUPMC