Provider Demographics
NPI:1811658263
Name:DZIOK, CHRISTOPHER LAURENT (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LAURENT
Last Name:DZIOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-775-8282
Mailing Address - Fax:888-838-5171
Practice Address - Street 1:130 NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-775-8282
Practice Address - Fax:508-775-8280
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2142363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty