Provider Demographics
NPI:1821161183
Name:NORTHRUP, CHRISTINE DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DEE
Last Name:NORTHRUP
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:PO BOX 850
Mailing Address - Street 2:5138 SHELBURNE RD
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0850
Mailing Address - Country:US
Mailing Address - Phone:802-985-2585
Mailing Address - Fax:802-985-5092
Practice Address - Street 1:5138 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6698
Practice Address - Country:US
Practice Address - Phone:802-985-2585
Practice Address - Fax:802-985-5092
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1442Medicaid
VT11128895OtherBCBS
VT4661801OtherFLETCHER ALLEN HEALTH CAR
VT11128895OtherBCBS
VT4661801OtherFLETCHER ALLEN HEALTH CAR