Provider Demographics
NPI:1750388393
Name:DIEROLF, CHRISTINA C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:C
Last Name:DIEROLF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:50 MEMORIAL BLVD
Mailing Address - Street 2:AQUIDNECK MEDICAL ASSOCIATES, INC
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3587
Mailing Address - Country:US
Mailing Address - Phone:401-683-2290
Mailing Address - Fax:401-849-8446
Practice Address - Street 1:77 TURNPIKE AVE
Practice Address - Street 2:AQUIDNECK MEDICAL ASSOCIATES, INC
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1419
Practice Address - Country:US
Practice Address - Phone:401-683-2290
Practice Address - Fax:401-849-8446
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-11-30
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Provider Licenses
StateLicense IDTaxonomies
RIMD08861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020234Medicaid
RI9020234Medicaid
RI007005295Medicare PIN