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General NPI Number Information
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NPI Number | 1790878684
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Entity Type | Individual
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Provider Name | CHRISTIE A HUDDLESTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 BALA AVE SUITE 308
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3212
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Country | US
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Telephone | 610-667-3760
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Fax | 610-668-0626
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Provider Business Mailing Address
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Address Line | 300 KENT RD
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City | BALA CYNWYD
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State | PA
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Zip | 19004-2834
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Country | US
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Telephone | 610-667-3760
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Fax | 610-668-0626
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD022824E
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License Number State | PA
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