Provider Demographics
NPI:1689708117
Name:NORTHRUP, CHRISTIANE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:LOUISE
Last Name:NORTHRUP
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 1:12 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6768
Mailing Address - Country:US
Mailing Address - Phone:207-846-8889
Mailing Address - Fax:207-846-8953
Practice Address - Street 1:12 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6768
Practice Address - Country:US
Practice Address - Phone:207-846-8889
Practice Address - Fax:207-846-8953
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009670207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB97509Medicare UPIN
MEMM0510Medicare ID - Type Unspecified