Provider Demographics
NPI:1104876234
Name:CHRISTIE, SCHEUSTER EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SCHEUSTER
Middle Name:EMMANUEL
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4320
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-5237
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4320
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-5237
Practice Address - Fax:860-714-8311
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012676208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001267699Medicaid
CT001267699Medicaid
D02963Medicare UPIN