Provider Demographics
NPI:1710077268
Name:TELLEFSEN, CHRISTIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:
Last Name:TELLEFSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 SAINT PAUL ST
Mailing Address - Street 2:SUITE 815 POB
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-323-8767
Mailing Address - Fax:410-560-7247
Practice Address - Street 1:301 SAINT PAUL ST
Practice Address - Street 2:SUITE 815 POB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-323-8767
Practice Address - Fax:410-560-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD313582084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70493Medicare UPIN