Provider Demographics
NPI:1124070818
Name:BORN, CHRISTOPHER T (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:BORN
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-457-1560
Mailing Address - Fax:401-831-8992
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:STE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:401-457-1560
Practice Address - Fax:401-831-8992
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11855207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057963Medicaid
007057963Medicare ID - Type Unspecified