Healthcare Provider Details

I. General information

NPI: 1013458520
Provider Name (Legal Business Name): CHRISTINE M. KOENIGBAUER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD MICU, 3RD FLOOR, RM 3E46
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD MICU, 3RD FLOOR, RM 3E46
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-3475
  • Fax:
Mailing address:
  • Phone: 302-733-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058883
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007867
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001116
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: