Provider Demographics
NPI:1871095018
Name:KRUKONIS, CHRISTOPHER EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:KRUKONIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 COMMON LN
Mailing Address - Street 2:
Mailing Address - City:PRIDES CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:01965-5413
Mailing Address - Country:US
Mailing Address - Phone:978-998-9053
Mailing Address - Fax:
Practice Address - Street 1:72 E CONCORD ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2307
Practice Address - Country:US
Practice Address - Phone:978-998-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant