Individual
CHRISTOPHER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-7797
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-1709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9702
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103651YPNH01
ANTHEM BC/BS
NH
01
—
080183074
RAILROAD MEDICARE
—
05
—
30009864
—
NH
01
—
5830418
AETNA GROUP
—
01
—
6861833
CIGNA HEALTHCARE
NH
01
—
9702
STATE LICENSE #
NH
Enumeration date
08/11/2005
Last updated
03/07/2023
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