Provider Demographics
NPI:1205805413
Name:CHRISTIE, PETER NICHOLAS (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NICHOLAS
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5540
Mailing Address - Country:US
Mailing Address - Phone:610-565-1919
Mailing Address - Fax:610-566-8971
Practice Address - Street 1:1215 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 13
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5540
Practice Address - Country:US
Practice Address - Phone:610-565-1919
Practice Address - Fax:610-566-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005633L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C27719Medicare UPIN
PA021762Medicare ID - Type Unspecified