MEDICARE: VIORICA MARIA CRISAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	20464	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386630671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIORICA MARIA CRISAN MD

Provider Business Mailing Address
First Line	:	1115 SAINT MELLION DR
Second Line	:
City	:	PRESTO
State	:	PA
Zip	:	15142-1009
Country	:	US
Telephone Number	:	412-600-1712
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 COLLIERS WAY
Second Line	:	SUITE 406
City	:	WEIRTON
State	:	WV
Zip	:	26062-5053
Country	:	US
Telephone Number	:	304-723-5670
Fax Number	:	304-723-5672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	11/25/2007

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