1033129499 NPI number — CHRISTINE ANNE DEGNON MD

Table of content: (NPI 1053062018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033129499 NPI number — CHRISTINE ANNE DEGNON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGNON
Provider First Name:
CHRISTINE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCFARLIN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
DEGNON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033129499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 SAVANNAH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-786-0828
Provider Business Mailing Address Fax Number:
302-200-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 SAVANNAH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-786-0828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

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: 207Q00000X , with the licence number:  058087 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME111108 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: Q9145 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 251294760D . This is a "OLD GA MEDICAID ID FOR SCREVEN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 01348056 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00819758 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 582162071-014 . This is a "TRICARE AFFILIATION ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251294760F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750314183 . This is a "COMMUNITY HEALTH CENTER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 251294760E . This is a "OLD GA MEDICAID ID FOR SCREVEN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52222516-004 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08CBCNB . This is a "OLD MEDICARE PTAN FOR SCREVEN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GA1033 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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