Provider Demographics
NPI:1023337136
Name:PROBST, CHRISTIAN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:PATRICK
Last Name:PROBST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:180 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2344
Mailing Address - Country:US
Mailing Address - Phone:772-485-6806
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX SURG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2723
Practice Address - Fax:585-276-2504
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN14729208600000X
NY271344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery