Provider Demographics
NPI:1396747366
Name:CHRISTIE, WILLIAM CLARK (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARK
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:105 BRANDT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6437
Mailing Address - Country:US
Mailing Address - Phone:724-772-5420
Mailing Address - Fax:724-772-5423
Practice Address - Street 1:105 BRANDT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6437
Practice Address - Country:US
Practice Address - Phone:724-772-5420
Practice Address - Fax:724-772-5423
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037014E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01202691Medicaid
PA01202691Medicaid
PA607847Medicare PIN