Provider Demographics
NPI:1710988092
Name:CHRISTIANSEN, LEIF ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:LEIF
Middle Name:ERIC
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1830
Mailing Address - Country:US
Mailing Address - Phone:610-370-2511
Mailing Address - Fax:610-370-3266
Practice Address - Street 1:2234 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-1830
Practice Address - Country:US
Practice Address - Phone:610-370-2511
Practice Address - Fax:610-370-3266
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-02-28
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PAOS-005747-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011169560Medicaid
PA134429JPUMedicare PIN
PA011169560Medicaid