Healthcare Provider Details

I. General information

NPI: 1588928188
Provider Name (Legal Business Name): CHRISTINE LEE PERSINGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NORTHPARKE DR
SPRINGFIELD OH
45503-1117
US

IV. Provider business mailing address

211 NORTHPARKE DR
SPRINGFIELD OH
45503-1117
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-1700
  • Fax: 937-390-2471
Mailing address:
  • Phone: 937-390-1700
  • Fax: 937-390-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number27834
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.138119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: