Provider Demographics
NPI:1851307342
Name:CHRISTIANA SPINE, PA
Entity Type:Organization
Organization Name:CHRISTIANA SPINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-623-4161
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:STE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:302-623-4289
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:STE 3302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE207X00000XMedicaid
2291480OtherAETNA/USHC
720356OtherPERSONAL CHOICE
CB6441OtherRAILROAD MEDICARE
DE5103889378OtherBLUE CROSS BLUE SHIELD
77069000OtherAMERIHEALTH/KEYSTONE
DE5103889378OtherBLUE CROSS BLUE SHIELD
=========OtherTRICARE/CHAMPUS
DE207X00000XMedicaid
=========OtherTRICARE/CHAMPUS