Provider Demographics
NPI:1962792150
Name:REGAN, CHRISTINE RENEE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:REGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PORTAGE TRAIL EXT W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3613
Mailing Address - Country:US
Mailing Address - Phone:330-928-3111
Mailing Address - Fax:
Practice Address - Street 1:265 PORTAGE TRAIL EXT W
Practice Address - Street 2:SUITE 200
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3613
Practice Address - Country:US
Practice Address - Phone:330-928-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine