1669447546 NPI number — CHRISTINE C PLATT M.D., P.H.D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669447546 NPI number — CHRISTINE C PLATT M.D., P.H.D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PLATT

Provider First Name:

CHRISTINE

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D., P.H.D

Provider Gender Code:

F

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:

1669447546

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/05/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

58 SUMMIT DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ROCHESTER

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14620-3130

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

585-461-2017

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 LAKEVIEW PARK

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROCHESTER

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14613-1708

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

585-458-2020

Provider Business Practice Location Address Fax Number:

585-458-3477

Provider Enumeration Date:

02/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  160134 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332H00000X , with the licence number: 160134 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207W00000X , with the licence number: 160134 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 5930359 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 8897 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 300238 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01038619 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 161305396 . This is a "PRINCIPAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P010160134 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 102473CR . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 161305396 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 161305396 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".