MEDICARE: DR. CHRISTINE S. DOTTERER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD023895E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE S. DOTTERER MD

Provider Business Mailing Address
First Line	:	113 N MARKET ST
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-1941
Country	:	US
Telephone Number	:	570-374-0202
Fax Number	:	570-374-7601

Provider Business Practice Location Address
First Line	:	113 N MARKET ST
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-1941
Country	:	US
Telephone Number	:	570-374-0202
Fax Number	:	570-374-7601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/21/2010

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