Provider Demographics
NPI:1962624304
Name:CORDIMA, CHRISTOPHER THOMAS
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:CORDIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2220
Mailing Address - Country:US
Mailing Address - Phone:617-629-2600
Mailing Address - Fax:617-666-9302
Practice Address - Street 1:690 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2220
Practice Address - Country:US
Practice Address - Phone:617-629-2600
Practice Address - Fax:617-666-9302
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1699865Medicaid
MA712331OtherTUFTS
MAY35921OtherBCBS
MA0115865OtherCIGNA
MA2864703OtherAETNA
MA351398OtherHARVARD PILGRIM
MA712331OtherTUFTS