Healthcare Provider Details

I. General information

NPI: 1508022070
Provider Name (Legal Business Name): CHRISTINE HARTER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 W UNION HILLS DR STE A180
GLENDALE AZ
85308
US

IV. Provider business mailing address

6320 W UNION HILLS DR STE A180
GLENDALE AZ
85308-7153
US

V. Phone/Fax

Practice location:
  • Phone: 623-748-8300
  • Fax: 623-748-8314
Mailing address:
  • Phone: 623-748-8300
  • Fax: 623-748-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29110
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number29110
License Number StateAZ

VIII. Authorized Official

Name: DR. CHRISTINE A. HARTER
Title or Position: MD/OWNER
Credential: MD
Phone: 623-748-8300