Provider Demographics
NPI:1942403381
Name:DEMOPULOS, CHRISTINA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIA
Last Name:DEMOPULOS
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 1:7525 SE 24TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2336
Mailing Address - Country:US
Mailing Address - Phone:206-230-0330
Mailing Address - Fax:206-230-0336
Practice Address - Street 1:7525 SE 24TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2336
Practice Address - Country:US
Practice Address - Phone:206-230-0330
Practice Address - Fax:206-230-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG37173Medicare UPIN