Provider Demographics
NPI:1801865290
Name:JONES, CHRISTINE L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:IVYDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25113-8263
Mailing Address - Country:US
Mailing Address - Phone:304-286-4200
Mailing Address - Fax:304-286-2107
Practice Address - Street 1:797 CLINIC DR
Practice Address - Street 2:
Practice Address - City:IVYDALE
Practice Address - State:WV
Practice Address - Zip Code:25113-8263
Practice Address - Country:US
Practice Address - Phone:304-286-4200
Practice Address - Fax:304-286-2107
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720368OtherMS BCBS
WV3810000799Medicaid
WVCI2575OtherMMRR
WV7162565OtherAETNA
WV001720368OtherMS BCBS
WVCI2575OtherMMRR
WVI16197Medicare UPIN
WV3810000799Medicaid
WV2027791Medicare PIN
WV2027795Medicare PIN