Provider Demographics
NPI:1316975097
Name:EVANCHICK, CHRISTINE C (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:EVANCHICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3300
Practice Address - Country:US
Practice Address - Phone:413-739-5676
Practice Address - Fax:413-739-2278
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58598207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ05700OtherBLUE CROSS BLUE SHIELD
CT010058598MA01OtherBLUE CROSS BLUE SHIELD
MA3013545Medicaid
MA058598OtherTUFTS HEALTH PLAN
MA23819OtherHEALTH NEW ENGLAND
MA058598OtherTUFTS HEALTH PLAN
CT010058598MA01OtherBLUE CROSS BLUE SHIELD