Provider Demographics
NPI:1932109527
Name:BRYKE, CHRISTINE R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:BRYKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3648
Mailing Address - Fax:617-975-5712
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3648
Practice Address - Fax:617-975-5712
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177523-1207SC0300X, 207SG0201X
WI33237-20207SC0300X, 207SG0201X
MA258736207SC0300X, 207SG0201X
VA0101251188207SG0201X, 207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32516200OtherMANAGED HEALTH
WI391939836OtherWPS
WI5241745OtherAETNA
WI391939836OtherHEALTH EOS
WI391939836014OtherBLUE CROSS
WI370021631Medicare PIN
WI120003406OtherWEA
WI2132702001OtherAMERICHOICE
WI32516200Medicaid
WI391939836002OtherCIGNA
WIE59963Medicare UPIN
WI391939836AOtherHUMANA
WI000173776Medicare PIN
WI6344590OtherABRI
WI7400178OtherUNITED HEALTHCARE