1730576125 NPI number — DR. CHRISTINE VICTORIA PINTO MD, MSC

Table of content: DR. CHRISTINE VICTORIA PINTO MD, MSC (NPI 1730576125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730576125 NPI number — DR. CHRISTINE VICTORIA PINTO MD, MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINTO
Provider First Name:
CHRISTINE
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MSC
Provider Gender Code:
F

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:
1730576125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/03/2015
NPI Reactivation Date:
01/15/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4755 OGLETOWN STANTON RD STE 5A43
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19718-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-554-2284
Provider Business Mailing Address Fax Number:
410-554-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4755 OGLETOWN STANTON RD STE 5A43
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19718-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-623-0188
Provider Business Practice Location Address Fax Number:
410-554-2184
Provider Enumeration Date:
04/23/2015

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: 207R00000X , with the licence number:  C1-0012730 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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