Individual provider Active NPI

Christine M. Koenigbauer, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1013458520
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0001116 Issued in DE
Practice address
4755 Ogletown Stanton Rd
Micu, 3Rd Floor, RM 3E46
Newark, DE 19718-2200
Phone
(302) 733-3475
NPI assigned
Mar 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA058883 PA
Physician Assistant 363A00000X C0007867 MD
Physician Assistant 363A00000X C5-0001116 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd
Micu, 3Rd Floor, RM 3E46
Newark, DE 19718-2200

Mailing address

4755 Ogletown Stanton Rd
Micu, 3Rd Floor, RM 3E46
Newark, DE 19718-2200
Phone (302) 733-3475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170720000961 DE Practitioner - Physician Assistant 9739459900 Reassigns benefits to 1 organization
I20211122001127 MD Practitioner - Physician Assistant 9739459900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4745 Ogletown Stanton Rd
Newark, DE 19713-2074
Phone (302) 623-7600

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

501 W 14TH St
Wilmington, DE 19801-1013
Phone (302) 623-7600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C5-0001116DEMDPhysician Assistant
C0007867MDMDPhysician Assistant
MA058883PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince May 24, 2017 Accepting new patients
Union Hospital of Cecil County CurrentSince Aug 16, 2021 Accepting new patients
Christiana Care Health Services Inc CurrentSince May 24, 2017 Accepting new patients
Union Hospital of Cecil County, Inc. CurrentSince Aug 16, 2021 Accepting new patients
Jonathan Larson MD PC Past Accepting new patients

Locations

4755 Ogletown Stanton Rd
Fl 3
Newark, DE 19718
Phone (302) 733-3475

4745 Stanton Ogletwn Rd
Newark, DE 19713
Phone (302) 623-7600

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1013458520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "address_2": "MICU, 3RD FLOOR, RM 3E46",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "address_2": "MICU, 3RD FLOOR, RM 3E46",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIGBAUER",
        "first_name": "CHRISTINE",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-16",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058883",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0007867",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.