Healthcare Provider Details

I. General information

NPI: 1942290358
Provider Name (Legal Business Name): CHRISTINA MARIE LIEPKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E SCHUYLER ST
OSWEGO NY
13126-1161
US

IV. Provider business mailing address

33 E SCHUYLER ST
OSWEGO NY
13126-1161
US

V. Phone/Fax

Practice location:
  • Phone: 315-343-6974
  • Fax:
Mailing address:
  • Phone: 315-343-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35082094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: