Provider Demographics
NPI:1104050681
Name:WATERS, CHRISTANNAH M (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTANNAH
Middle Name:M
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTANNAH
Other - Middle Name:M
Other - Last Name:DOMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:62 BROWN ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:978-912-7450
Mailing Address - Fax:978-912-7420
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-912-7450
Practice Address - Fax:978-912-7420
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083619AMedicaid
MA747307OtherTUFTS
MAAA148729OtherHPHC
8627124OtherCIGNA
9805333OtherAETNA
MA001230601Medicare PIN