Provider Demographics
NPI:1952764334
Name:BOLTON, CHRISTINA M (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CONSTANTINIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5210 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1920
Mailing Address - Country:US
Mailing Address - Phone:973-886-8285
Mailing Address - Fax:321-203-4630
Practice Address - Street 1:7243 DELLA DR FL 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5104
Practice Address - Country:US
Practice Address - Phone:407-381-7366
Practice Address - Fax:321-203-4630
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36161657207Q00000X
KY55442207Q00000X
COCDR.0003813207Q00000X
NJ25IA12171500207Q00000X
CT77688207Q00000X
GA93351207Q00000X
OH146614207Q00000X
NY319127207Q00000X
VA101276478207Q00000X
FLME140473207Q00000X
TXT8985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine