Provider Demographics
NPI:1215072095
Name:HEALEY, CHRISTOPHER THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:HEALEY
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 1:400 SOUTHBOROUGH DR STE 400-102
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3249
Mailing Address - Country:US
Mailing Address - Phone:207-464-8288
Mailing Address - Fax:207-274-7848
Practice Address - Street 1:400 SOUTHBOROUGH DR STE 400-102
Practice Address - Street 2:
Practice Address - City:S PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3249
Practice Address - Country:US
Practice Address - Phone:207-464-8288
Practice Address - Fax:207-274-7848
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2239182086S0129X
MEMD174132086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00435576OtherRR MEDICARE
ME432730199Medicaid
MEP00435576OtherRR MEDICARE
ME000283503Medicare PIN
ME283501Medicare PIN