Healthcare Provider Details

I. General information

NPI: 1952586497
Provider Name (Legal Business Name): CHRISTINE ELIZABETH MACKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DANBURY RD
WILTON CT
06897-4427
US

IV. Provider business mailing address

55 DANBURY RD
WILTON CT
06897-4427
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-3363
  • Fax: 203-762-1999
Mailing address:
  • Phone: 203-762-3363
  • Fax: 203-762-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-34185
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number047554
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: