Healthcare Provider Details

I. General information

NPI: 1205809001
Provider Name (Legal Business Name): CHRISTOPHER J HASSELTINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 LAMME RD
MORAINE OH
45439-3215
US

IV. Provider business mailing address

5350 LAMME RD
MORAINE OH
45439-3215
US

V. Phone/Fax

Practice location:
  • Phone: 937-534-4620
  • Fax: 937-522-8799
Mailing address:
  • Phone: 937-534-4620
  • Fax: 937-522-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD426412
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK2034
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35075689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: