1497736474 NPI number — CHRISTOPHER CUA MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	CUA
Provider First Name	:	CHRISTOPHER
Provider Middle Name	:
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

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	:	1497736474
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	PO BOX 9135
Provider Second Line Business Mailing Address	:	ATT:SHARON SILVA
Provider Business Mailing Address City Name	:	BROOKLINE
Provider Business Mailing Address State Name	:	MA
Provider Business Mailing Address Postal Code	:	024469135
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8009270002
Provider Business Mailing Address Fax Number	:

Provider First Line Business Practice Location Address	:	1153 CENTRE ST
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	JAMAICA PLAIN
Provider Business Practice Location Address State Name	:	MA
Provider Business Practice Location Address Postal Code	:	021303446
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6175220811
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Title or Position	:
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• Taxonomy code: 174400000X , with the licence number:  70534 , registered in the state of MA .

• Identifier: 3048101 , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: E14160 . This identifiers is of the category "".
• Identifier: J08634 , issued by the state of ( MA ) . This identifiers is of the category "".