Provider Demographics
NPI:1912908393
Name:CHRISTIE, SHARON MARIE (MD)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:MARIE
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4820
Mailing Address - Fax:860-358-8661
Practice Address - Street 1:540 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4711
Practice Address - Country:US
Practice Address - Phone:860-358-2780
Practice Address - Fax:860-358-2781
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038326207NS0135X
CT38326207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010038326CT02OtherBCBS
0V7245OtherHEALTH NET
P2064320OtherOXFORD
2340445OtherAETNA
150894OtherCONNECTICARE
401367OtherHARVARD PILGRIM
070014961OtherRAILROAD MEDICARE
070014961OtherRAILROAD MEDICARE
P2064320OtherOXFORD