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NPI Code Detail

MEDICARE: CHRISTOPHER LAKE MD

MEDICARE: CHRISTOPHER LAKE 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
1207Q00000XFamily Medicine Physician9702NH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4080183074OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15830418OTHERAETNA GROUP
20103651YPNH01OTHERNHANTHEM BC/BS
39702OTHERNHSTATE LICENSE #
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
66861833OTHERNHCIGNA HEALTHCARE

General Provider Information

NPI Number : 1619979564
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER LAKE MD
Provider Business Mailing Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-1709
Provider Business Practice Location Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-7797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 03/07/2023

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Directions to “ CHRISTOPHER LAKE MD” Practice Location

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