Provider Demographics
NPI:1760447718
Name:CHRISTIAN, CORA LE ETHEL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CORA
Middle Name:LE ETHEL
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 EG LA GRANGE
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00840-1338
Mailing Address - Country:US
Mailing Address - Phone:340-772-3665
Mailing Address - Fax:340-772-3463
Practice Address - Street 1:40 EG LA GRANGE
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840-1338
Practice Address - Country:US
Practice Address - Phone:340-772-3665
Practice Address - Fax:340-772-3463
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0024376Medicare ID - Type Unspecified