Provider Demographics
NPI:1497215339
Name:MCKENNA, CHRISTINA RODRIGUEZ (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RODRIGUEZ
Last Name:MCKENNA
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 1:17 N MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 BERKMAR CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-220-3420
Practice Address - Fax:434-220-3422
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-08-28
Deactivation Date:2024-08-16
Deactivation Code:
Reactivation Date:2024-08-20
Provider Licenses
StateLicense IDTaxonomies
VA0101279140207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology