Basic Information
Provider Information | |||||||||
NPI: | 1578664108 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIRKPATRICK | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | LOWELL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VANDER VEER | ||||||||
OtherFirstName: | CHRISTINA | ||||||||
OtherMiddleName: | LOWELL | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 250 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NH | ||||||||
PostalCode: | 033017539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032277000 | ||||||||
FaxNumber: | 6032277191 | ||||||||
Practice Location | |||||||||
Address1: | 250 PLEASANT ST | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NH | ||||||||
PostalCode: | 033017539 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032277000 | ||||||||
FaxNumber: | 6032277191 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2006 | ||||||||
LastUpdateDate: | 04/19/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13867 | NH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 13867 | NH | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | AA114841 | 01 | NH | HARVARD PILGRIM HEALTH CARE | OTHER | 01Y013333NH01 | 01 | NH | ANTHEM BC/BS | OTHER | 30207568 | 05 | NH |   | MEDICAID |