Provider Demographics
NPI:1447256375
Name:DOTTERER, CHRISTINE S (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:S
Last Name:DOTTERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1941
Mailing Address - Country:US
Mailing Address - Phone:570-374-0202
Mailing Address - Fax:570-374-7601
Practice Address - Street 1:113 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1941
Practice Address - Country:US
Practice Address - Phone:570-374-0202
Practice Address - Fax:570-374-7601
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023895E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00857769Medicaid
PA069856Medicare ID - Type Unspecified
PA00857769Medicaid
PA34881Medicare UPIN