Provider Demographics
NPI:1760697924
Name:MATIVO, CHRISTINE SYOKAU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SYOKAU
Last Name:MATIVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:SYOKAU
Other - Last Name:MUTUNGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9207 BROKEN TIMBER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2309
Mailing Address - Country:US
Mailing Address - Phone:240-688-4428
Mailing Address - Fax:
Practice Address - Street 1:9207 BROKEN TIMBER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2309
Practice Address - Country:US
Practice Address - Phone:240-688-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD035386800Medicaid
MD035386800Medicaid