Provider Demographics
NPI:1750473609
Name:CONSTANTINO, CHRISTINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL RD
Mailing Address - Street 2:STE 103 ATTN DEBORAH SMOOTZ
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4015
Mailing Address - Country:US
Mailing Address - Phone:410-414-4846
Mailing Address - Fax:410-414-4810
Practice Address - Street 1:10845 TOWN CENTER BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2712
Practice Address - Country:US
Practice Address - Phone:410-257-5263
Practice Address - Fax:410-257-5341
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606MMedicare ID - Type UnspecifiedMEDICARE