Provider Demographics
NPI:1699796458
Name:DAMANDA, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DAMANDA
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 1:801 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4212
Mailing Address - Country:US
Mailing Address - Phone:215-787-2000
Mailing Address - Fax:215-787-2115
Practice Address - Street 1:1600 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-787-2000
Practice Address - Fax:215-787-2115
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015059E207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1125305OtherKEYSTONE MERCY
PA7990000015OtherRR MEDICARE
PA000964295Medicaid
PA0096429502OtherAMERICHOICE
PA117015OtherCBH
PA13361OtherHEALTH PARTNERS
PA7990000015OtherRR MEDICARE
PA137173GHDMedicare PIN
D71243Medicare UPIN