Basic Information
| Provider Information | |||||||||
| NPI: | 1417936121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRIST | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 STEPHANIE RD | ||||||||
| Address2: | |||||||||
| City: | BIRDSBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195089416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662972320 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | BOX 316 | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 04/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | MD028059E | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0010527720002 | 05 | PA | MEDICAID |