Healthcare Provider Details

I. General information

NPI: 1679733422
Provider Name (Legal Business Name): CHRISTIN A. KNOWLTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

PO BOX 63099 DEPT. 4099
CHARLOTTE NC
28263-3099
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3131
  • Fax: 203-789-3133
Mailing address:
  • Phone: 203-789-3131
  • Fax: 203-789-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMT189860
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number049596
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: