Healthcare Provider Details

I. General information

NPI: 1255593836
Provider Name (Legal Business Name): CHRISTINE AGNES CIUNCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE AGNES MARTIN MD

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NORTH 39TH ST. MEDICAL ARTS BLDG. SUITE 103A
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

51 NORTH 39TH ST. MEDICAL ARTS BLDG. SUITE 103A
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9801
  • Fax:
Mailing address:
  • Phone: 215-662-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD441713
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: