MEDICARE: CHRISTINA RALPH PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810003847	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11545094	OTHER		CAQH
2	373345	OTHER	KY	TRICARE

General Provider Information

NPI Number	:	1104879188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA RALPH PH.D

Provider Business Mailing Address
First Line	:	PO BOX 9252
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20195-3152
Country	:	US
Telephone Number	:	703-596-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 CHEROKEE AVE
Second Line	:	SUITE 411
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2052
Country	:	US
Telephone Number	:	703-596-9476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/09/2015

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