Provider Demographics
NPI:1962670455
Name:DINICOLA, CHRISTINA ILSE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ILSE
Last Name:DINICOLA
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 1:1001 LAUREL OAK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3512
Mailing Address - Country:US
Mailing Address - Phone:856-782-7400
Mailing Address - Fax:856-782-7404
Practice Address - Street 1:1001 LAUREL OAK RD
Practice Address - Street 2:SUITE B
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3512
Practice Address - Country:US
Practice Address - Phone:856-782-7400
Practice Address - Fax:856-782-7404
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08994900208000000X
PAMD426793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024133070001Medicaid