Basic Information
| Provider Information | |||||||||
| NPI: | 1487815601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKUN | ||||||||
| FirstName: | CHRISTAL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E OTTERMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128513256 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 E OTTERMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25291 | NE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A124247 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.