MEDICARE: DR. CHRISTINA E. GENERIE OD

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	152W00000X	Optometrist	DA1997	MD
2	152W00000X	Optometrist	OP1000119	DC
3	152W00000X	Optometrist	TA1997	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11625596	OTHER	MD	CAQH

General Provider Information

NPI Number	:	1255432928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA E. GENERIE OD

Provider Business Mailing Address
First Line	:	6230 OLD DOBBIN LN STE 190
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5954
Country	:	US
Telephone Number	:	443-420-8113
Fax Number	:	443-973-6998

Provider Business Practice Location Address
First Line	:	6230 OLD DOBBIN LN STE 190
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5954
Country	:	US
Telephone Number	:	443-420-8113
Fax Number	:	443-973-6998

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/07/2025

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