Provider Demographics
NPI:1871585190
Name:CUSTER, CHRISTOPHER CRAIG (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CRAIG
Last Name:CUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2614
Mailing Address - Country:US
Mailing Address - Phone:717-242-1633
Mailing Address - Fax:
Practice Address - Street 1:4612 WESTBRANCH HIGHWAY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-523-3462
Practice Address - Fax:570-524-4197
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 030589-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010420790002Medicaid
PAC33579Medicare UPIN
PA0010420790002Medicaid