Provider Demographics
NPI:1912050238
Name:HYSON, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:HYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1805
Mailing Address - Country:US
Mailing Address - Phone:518-897-2317
Mailing Address - Fax:518-897-2423
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1805
Practice Address - Country:US
Practice Address - Phone:518-897-2317
Practice Address - Fax:518-897-2423
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00656304Medicaid
NY175503OtherNEW YORK STATE LICENSE
NY141731786OtherTAX ID
NY00656304Medicaid
NY141731786OtherTAX ID