Provider Demographics
NPI:1841247012
Name:AMIS, CHRISTINE J IV (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:J
Last Name:AMIS
Suffix:IV
Gender:F
Credentials:MD
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Mailing Address - Street 1:923 ROUTE 6A
Mailing Address - Street 2:SUNFLOWER MKT PLC UNIT N
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2159
Mailing Address - Country:US
Mailing Address - Phone:508-360-5195
Mailing Address - Fax:508-544-4266
Practice Address - Street 1:923 ROUTE 6A
Practice Address - Street 2:SUNFLOWER MKT PLC UNIT N
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2159
Practice Address - Country:US
Practice Address - Phone:508-360-5195
Practice Address - Fax:508-544-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MA2195182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2023558OtherCIGNA
MA004108074Medicaid
MA110078110AOtherMMIS
MA219518OtherMD LICENSE IN MA
MA013545330AOtherPTAN ID
MA2147092OtherMASS HEALTH
MAJ29522OtherBC/BS
MA494241OtherTUFTS
MABA9287740OtherDEA
MA004108074Medicaid
MA110078110AOtherMMIS