Provider Demographics
NPI:1811953318
Name:WELLER, CHRISTINE B (DO, CMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:B
Last Name:WELLER
Suffix:
Gender:F
Credentials:DO, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751595
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-1595
Mailing Address - Country:US
Mailing Address - Phone:937-203-3079
Mailing Address - Fax:937-886-6609
Practice Address - Street 1:1930 N LAKEMAN DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1239
Practice Address - Country:US
Practice Address - Phone:937-203-3079
Practice Address - Fax:937-886-6609
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006682W207Q00000X
OH34006682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147885Medicaid
OHH459470Medicare PIN
OHH06186Medicare UPIN
OH0147885Medicaid