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NPI Code Detail

MEDICARE: DR. KRISTA CIVILETTI D.O.

MEDICARE: DR. KRISTA CIVILETTI D.O.
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
1207Q00000XFamily Medicine PhysicianOS012949PA
2207Q00000XFamily Medicine Physician2014-02119NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NCP490BOTHERNCMEDICARE PTAN

General Provider Information

NPI Number : 1548350382
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTA CIVILETTI D.O.
Provider Business Mailing Address
First Line : 2000 PERIMETER PARK DR
Second Line : SUITE 200
City : MORRISVILLE
State : NC
Zip : 27560-8442
Country : US
Telephone Number : 919-563-2896
Fax Number :
Provider Business Practice Location Address
First Line : 75 FREEDOM PKWY STE C
Second Line :
City : PITTSBORO
State : NC
Zip : 27312-4939
Country : US
Telephone Number : 919-545-0911
Fax Number : 919-545-0096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 05/06/2021

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Directions to “ DR. KRISTA CIVILETTI D.O.” Practice Location

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