1124099361 NPI number — DR. PAUL C CHRISTU MD

Table of content: DR. PAUL C CHRISTU MD (NPI 1124099361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124099361 NPI number — DR. PAUL C CHRISTU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTU
Provider First Name:
PAUL
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124099361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 N MAIN ST
Provider Second Line Business Mailing Address:
SUIT 1
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02904-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-9690
Provider Business Mailing Address Fax Number:
401-331-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 N MAIN ST
Provider Second Line Business Practice Location Address:
SUIT 1
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-9690
Provider Business Practice Location Address Fax Number:
401-331-9609
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  MD07568 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19891 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7026038 . This is a "AETNA-NON-HMO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 010007568 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 10-00232 . This is a "UNITED HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: J11786 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1594 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 20993-3 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3621783002 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2255530 . This is a "AETNA-HMO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 406470 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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