Provider Demographics
NPI:1053391565
Name:EGENOLF, CRISTI (MD)
Entity type:Individual
Prefix:
First Name:CRISTI
Middle Name:
Last Name:EGENOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BUTTRICK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3417
Mailing Address - Country:US
Mailing Address - Phone:603-537-1300
Mailing Address - Fax:
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-537-1300
Practice Address - Fax:603-434-3540
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3742083OtherAETNA USHC
NH792596OtherMVP
NH468068OtherTUFTS
NHG73110OtherHARVARD
NH30204901Medicaid
NH01YP07954NH01OtherANTHEM BCBS
NH792596OtherMVP
NH3742083OtherAETNA USHC