Provider Demographics
NPI:1770702391
Name:ALTSTATT, CHRISTINA M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:ALTSTATT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:180 KENNEDY MEMORIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4540
Mailing Address - Country:US
Mailing Address - Phone:207-872-2900
Mailing Address - Fax:207-872-8495
Practice Address - Street 1:180 KENNEDY MEMORIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4540
Practice Address - Country:US
Practice Address - Phone:207-872-2900
Practice Address - Fax:207-872-8495
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA001084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432554399Medicaid