Provider Demographics
NPI:1801838883
Name:CHRISTINE, CRAIG R (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:CHRISTINE
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5074 KERNSVILLE RD
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2320
Practice Address - Country:US
Practice Address - Phone:610-395-1993
Practice Address - Fax:610-395-2516
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004609L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50004449OtherCAPITAL BLUE CROSS
PA0050824000OtherKEYSTONE EAST
PA412033OtherHIGHMARK BLUE SHIELD
PA80066058OtherRAILROAD MEDICARE
PA412033Medicare ID - Type Unspecified
PAC33632Medicare UPIN