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General NPI Number Information
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NPI Number | 1023202769
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Entity Type | Individual
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Provider Name | CARL L. CHRISTIE DO
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 1415 PORTLAND AVE STE 220
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City | ROCHESTER
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State | NY
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Zip | 14621
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Country | US
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Telephone | 585-922-4496
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Fax | 585-922-4442
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone | 585-922-4496
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Fax | 585-922-4442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4267
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MB08459100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 309706
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License Number State | NY
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