MEDICARE: CHRISTA R WARTHLING RPAC

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	363A00000X	Physician Assistant	010668	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00057054601	OTHER	NY	BLUE CROSS/COMM BLUE
2	00027238201	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1750364840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA R WARTHLING RPAC

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD
Second Line	:	STE 208
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-2160
Fax Number	:	716-692-4342

Provider Business Practice Location Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2001
Fax Number	:	716-692-4342

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	04/30/2008

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