Provider Demographics
NPI:1851359210
Name:HOMISKI, CHRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:
Last Name:HOMISKI
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 1:2 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2309
Mailing Address - Country:US
Mailing Address - Phone:860-204-0332
Mailing Address - Fax:860-204-0115
Practice Address - Street 1:2 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2309
Practice Address - Country:US
Practice Address - Phone:860-204-0332
Practice Address - Fax:860-204-0115
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01004158CT03OtherANTHEM BLUE CROSS
CTIP001415802Medicaid
110008968Medicare ID - Type Unspecified
CTIP001415802Medicaid