Basic Information
| Provider Information | |||||||||
| NPI: | 1649269150 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADDIS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | LANCASTER GENERAL HOSPITAL | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175448144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | LANCASTER GENERAL HOSPITAL | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175448144 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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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 | 207R00000X | MD043006L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 563521 | 01 | PA | AETNA HMO | OTHER | E77514 | 01 | PA | HEALTH ASSURANCE | OTHER | 661702 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 33804 S1QA | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 02015602 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 110142857 | 01 | PA | RAILROAD MEDICARE | OTHER | 0012352800004 | 05 | PA | MEDICAID | 1519247 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | P002536 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 5182104 | 01 | PA | AETNA NON-HMO | OTHER |