Provider Demographics
NPI:1548268113
Name:DOPP, CHRISTINE ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:DOPP
Suffix:
Gender:F
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 1:6850 LOWS RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8729
Mailing Address - Country:US
Mailing Address - Phone:570-387-4368
Mailing Address - Fax:570-387-6344
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8729
Practice Address - Country:US
Practice Address - Phone:570-387-4368
Practice Address - Fax:570-387-6344
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07713223Medicaid
PA052850Medicare ID - Type UnspecifiedMEDICARE
PA07713223Medicaid