Provider Demographics
NPI:1245223064
Name:WESTERMANN, CHRISTIAN P (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:P
Last Name:WESTERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROUTE 347
Mailing Address - Street 2:BUILDING 19C, SUITE 72
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-751-9700
Mailing Address - Fax:631-751-6979
Practice Address - Street 1:2500 ROUTE 347
Practice Address - Street 2:BUILDING 19C, SUITE 72
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-751-9700
Practice Address - Fax:631-751-6979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NY157340207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64675Medicare UPIN
NY89D551Medicare ID - Type Unspecified