Provider Demographics
NPI:1639195043
Name:AZAR, KRISTINA M (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:M
Last Name:AZAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2400 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7645
Mailing Address - Country:US
Mailing Address - Phone:724-935-4700
Mailing Address - Fax:724-935-8376
Practice Address - Street 1:2400 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7645
Practice Address - Country:US
Practice Address - Phone:724-935-4700
Practice Address - Fax:724-935-8376
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS016702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI29734Medicare UPIN