Provider Demographics
NPI:1841258282
Name:KO, CHRISTINE J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:KO
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:PO BOX 208059
Mailing Address - Street 2:YALE DERMATOPATHOLOGY LABORATORY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8059
Mailing Address - Country:US
Mailing Address - Phone:203-785-4094
Mailing Address - Fax:203-785-6869
Practice Address - Street 1:15 YORK STREET
Practice Address - Street 2:LMP 5031
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-785-4094
Practice Address - Fax:203-785-6869
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426011207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101266539Medicaid
PA101266539Medicaid
PA090929Medicare ID - Type Unspecified