Provider Demographics
NPI:1821068560
Name:KING, CHRISTINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:KING
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 1:2001 E ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2811
Mailing Address - Country:US
Mailing Address - Phone:440-717-6100
Mailing Address - Fax:440-546-1382
Practice Address - Street 1:2001 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2811
Practice Address - Country:US
Practice Address - Phone:440-717-6100
Practice Address - Fax:440-546-1382
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000525094OtherANTHEM
OH2414122Medicaid
OH25351OtherQUAL
OHF52617OtherSUMMA
OH4113968Medicare PIN
OH2414122Medicaid
P00713825Medicare PIN
OH000000525094OtherANTHEM