Provider Demographics
NPI:1952586497
Name:MACKEN, CHRISTINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:MACKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6351
Mailing Address - Country:US
Mailing Address - Phone:203-268-1766
Mailing Address - Fax:
Practice Address - Street 1:132 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6351
Practice Address - Country:US
Practice Address - Phone:203-268-1766
Practice Address - Fax:203-268-0787
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPP-34185174N00000X
CT047554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174N00000XOther Service ProvidersLactation Consultant, Non-RN