Provider Demographics
NPI:1740444843
Name:HAAS, CHRISTINE H (MS, CNS, CPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:H
Last Name:HAAS
Suffix:
Gender:F
Credentials:MS, CNS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-1833
Mailing Address - Country:US
Mailing Address - Phone:571-241-7000
Mailing Address - Fax:703-564-8567
Practice Address - Street 1:1360 BEVERLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3643
Practice Address - Country:US
Practice Address - Phone:571-241-7000
Practice Address - Fax:703-564-8567
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNU100000124133N00000X
MDN00271133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC93570001OtherBCBS