Provider Demographics
NPI:1750380200
Name:WOLLSCHLAGER, CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WOLLSCHLAGER
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 1:9 WASHINGTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3267
Mailing Address - Country:US
Mailing Address - Phone:203-248-3013
Mailing Address - Fax:203-248-2878
Practice Address - Street 1:2416 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3248
Practice Address - Country:US
Practice Address - Phone:203-248-5276
Practice Address - Fax:203-287-9364
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031881207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010031881CT01OtherBLUE CROSS BLUE SHIELD
CT740001OtherCONNECTICARE
CT110185727OtherRAILROAD MEDICARE
CT0Q2058OtherHEALTH NET
CT2283071OtherAETNA
CTP998739OtherOXFORD
CT110185727OtherRAILROAD MEDICARE
CT110007545Medicare ID - Type Unspecified