Provider Demographics
NPI:1295480770
Name:CHRISTIE, MARY K (MED)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1737
Mailing Address - Country:US
Mailing Address - Phone:508-259-4665
Mailing Address - Fax:
Practice Address - Street 1:368 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1737
Practice Address - Country:US
Practice Address - Phone:508-259-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist