Provider Demographics
NPI:1063507036
Name:FLEURY, CHRISTINE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FLEURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 DEFENSE HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2403
Mailing Address - Country:US
Mailing Address - Phone:443-332-1533
Mailing Address - Fax:443-332-4271
Practice Address - Street 1:2209 DEFENSE HWY
Practice Address - Street 2:SUITE C
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2403
Practice Address - Country:US
Practice Address - Phone:443-332-1533
Practice Address - Fax:443-332-4271
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009124-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4151248OtherMVP
NY070418000045OtherFIDELIS
NY000403511005OtherBSNENY
NY02420313Medicaid
NY02420313Medicaid
NY070418000045OtherFIDELIS