Provider Demographics
NPI:1790878684
Name:HUDDLESTON, CHRISTIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:A
Last Name:HUDDLESTON
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 1:300 KENT RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2834
Mailing Address - Country:US
Mailing Address - Phone:610-667-3760
Mailing Address - Fax:610-668-0626
Practice Address - Street 1:1 BALA AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3212
Practice Address - Country:US
Practice Address - Phone:610-667-3760
Practice Address - Fax:610-668-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022824E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160629Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER