Provider Demographics
NPI:1962670455
Name:DINICOLA, CHRISTINA ILSE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ILSE
Last Name:DINICOLA
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:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-2000
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:
Practice Address - Street 1:40 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1377
Practice Address - Country:US
Practice Address - Phone:802-728-2420
Practice Address - Fax:802-728-2111
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426793208000000X
VT0420013072208000000X
NJ25MA08994900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024133070001Medicaid