Provider Demographics
NPI: | 1457390189 |
---|---|
Name: | CHRISTOPHE, KATHLEEN M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KATHLEEN |
Middle Name: | M |
Last Name: | CHRISTOPHE |
Suffix: | |
Gender: | F |
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: | 5045 US-130 |
Mailing Address - Street 2: | |
Mailing Address - City: | DELRAN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08075-2908 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-764-7660 |
Mailing Address - Fax: | 856-764-5723 |
Practice Address - Street 1: | 5045 US-130 |
Practice Address - Street 2: | |
Practice Address - City: | DELRAN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08075-2908 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-764-7660 |
Practice Address - Fax: | 856-764-5723 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-06 |
Last Update Date: | 2019-06-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD421558 | 207V00000X |
NJ | 25MA09044500 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0452238 | Medicaid | |
PA | 597586 | Other | MEDICARE GROUP TPI |
PA | 100849394 | Medicaid | |
PA | CD4829 | Other | RAILROAD MEDICARE TPI GROUP |
PA | 075049 | Medicare ID - Type Unspecified |