Healthcare Provider Details

I. General information

NPI: 1700958840
Provider Name (Legal Business Name): ANDREA MARIE CHRISTOPHERSON MCDONOUGH RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANDREA MARIE CHRISTOPHERSON

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CHESTNUT STREET SUITE 23
SPRINGFIELD MA
01107-1610
US

IV. Provider business mailing address

780 CHESTNUT STREET SUITE 23
SPRINGFIELD MA
01107-1610
US

V. Phone/Fax

Practice location:
  • Phone: 413-787-2800
  • Fax: 413-787-2822
Mailing address:
  • Phone: 413-787-2800
  • Fax: 413-787-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: