Provider Demographics
NPI:1538369657
Name:MUNROE, CHRISTINE M (DO)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:MUNROE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:NEUFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:57 PORTLAND ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1203
Mailing Address - Country:US
Mailing Address - Phone:207-384-9212
Mailing Address - Fax:207-384-2008
Practice Address - Street 1:57 PORTLAND ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1203
Practice Address - Country:US
Practice Address - Phone:207-384-9212
Practice Address - Fax:207-384-2008
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2005207R00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3022634Medicaid
ME432756499Medicaid
ME2005OtherSTATE LICENSE NUMBER
ME000265601OtherPTAN
ME000265601OtherPTAN