Provider Demographics
NPI:1245335058
Name:NEWKIRK, CHRISTINE L (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:BOUTZALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2601 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2007
Mailing Address - Country:US
Mailing Address - Phone:215-335-6000
Mailing Address - Fax:267-350-7497
Practice Address - Street 1:2601 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2007
Practice Address - Country:US
Practice Address - Phone:215-335-6000
Practice Address - Fax:267-350-7497
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58944207R00000X
PAMD439838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402283100Medicaid
MDH73798Medicare UPIN
MDF038Medicare ID - Type Unspecified