Provider Demographics
NPI:1972569465
Name:CHRISTIANSEN, GREGORY B (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:CHRISTIANSEN
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 1:100 TRICH DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5987
Mailing Address - Country:US
Mailing Address - Phone:724-225-8657
Mailing Address - Fax:724-228-8388
Practice Address - Street 1:100 TRICH DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5987
Practice Address - Country:US
Practice Address - Phone:724-225-8657
Practice Address - Fax:724-228-8388
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065259L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001819566Medicaid
PA001819566Medicaid
PA044433Medicare ID - Type Unspecified
PAG78359Medicare UPIN