Healthcare Provider Details

I. General information

NPI: 1831173061
Provider Name (Legal Business Name): TODD W CHRISTIE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 YANKEE ST STE 140
CENTERVILLE OH
45459-3475
US

IV. Provider business mailing address

7677 YANKEE ST STE 140
CENTERVILLE OH
45459-3475
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001859
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOH1859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: