Provider Demographics
NPI:1427267889
Name:CHRISOMALIS VALASIADIS, LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:CHRISOMALIS VALASIADIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:CHRISOMALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500A E 87TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7650
Mailing Address - Country:US
Mailing Address - Phone:212-879-7180
Mailing Address - Fax:212-879-7181
Practice Address - Street 1:500A E 87TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-7650
Practice Address - Country:US
Practice Address - Phone:212-879-7180
Practice Address - Fax:212-879-7181
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188898207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138682Medicare PIN