Provider Demographics
NPI:1669430047
Name:HEBERT, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE P
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-7702
Mailing Address - Fax:330-856-1096
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE P
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-7702
Practice Address - Fax:330-856-1096
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077466H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143586Medicaid
OH2143586Medicaid
OHHE7353151Medicare PIN